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Increase in Lumbar Spine Bone Mineral Content in Patients on Long-Term Parenteral Nutrition Without Vitamin D Supplementation

Home Parenteral Nutrition Unit, the Toronto Hospital and the University of Toronto, Ontario, Canada, University Hospital Rotterdam, Department of Internal Medicine II, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Wei K. Cheong, MB, BS

Home Parenteral Nutrition Unit, the Toronto Hospital and the University of Toronto, Ontario, Canada, Singapore General Hospital, Department of Medicine II, Outram Road Singapore 0316, Singapore

Johane P. Allard, MD

Home Parenteral Nutrition Unit, the Toronto Hospital and the University of Toronto, Ontario, Canada

Khursheed N. Jeejeebhoy, MB, BS, PHD

Home Parenteral Nutrition Unit, the Toronto Hospital and the University of Toronto, Ontario, Canada

Background: We had previously shown that short-term withdrawal of vitamin D in patients with metabolic bone disease complicating home parenteral nutrition (HPN) corrected osteomalacia. We therefore conducted a prospective study of the effect of long term withdrawal of vitamin D in patients on home parenteral nutrition. Methods: Baseline measurements of bone mineral content, serum levels of calcium, phosphorus, parathormone, 25-OH and 1,25 (OH)₂ D; urinary calcium; and bone mineral density were measured. Then all parenteral vitamin D was withdrawn and the above parameters were followed for a mean of 4.5 years. Results: Lumbar spine bone mineral content (LSBMC) was 0.79 ± 0.06 g/cm² at the start of the study, well below the reference value, 1.16 ± 0.13 g/cm². Parathyroid hormone (PTH) (0.48 ± 0.24 pmol/L) and 1,25-(OH)₂D levels (22.8 ± 7.9 pmol/L) were low and 25-hydroxyvitaniin D levels were normal (33.3 ± 5.5 nmol/L) before removing vitandn D from the HPN solutions. After withdrawal of vitamin D for 4.5 ± 0.2 years LSBMC increased from 0.79 ± 0.06 to 0.93 0.07 g/cm2 (p < 0.005). Calcium phosphorus, magnesium and 25-hydroxyvitamin D did not change significantly, 1,25(OH)2D, and PTH levels became normal after withdrawal of vitamin D. Conclusions: In selected patients with depressed PTH levels, long-term withdrawal of vitamin D during HPN increases LSBMC and levels of PTH and 1,25(OH)2D. There is no reduction of the mean level of 25-hydroxyvitamin D. (Journal of Parenteral and Enteral Nutrition 19:431-436, 1995)

Journal of Parenteral and Enteral Nutrition, Vol. 19, No. 6, 431-436 (1995)
DOI: 10.1177/0148607195019006431


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