Metabolic Bone Disease in Patients Receiving Long-Term Total Parenteral Nutrition

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Abstract
Ca and bone metabolism were studied in 16 patients receiving total parenteral nutrition for periods ranging from 7-89 mo. In 12 patients bone biopsies at 6-73 mo. after the start of parenteral nutrition showed osteomalacia. Plasma 25-hydroxyvitamin D levels were normal in all patients. Seven persons developed hypercalcemia and 10 had hypercalciuria with a negative Ca balance. Serum P was normal and plasma parathyroid hormone level, normal or decreased. Three patients with the severest form of the disease had vitamin D withdrawn from their solutions. Urinary Ca decreased and serum Ca became normal; 2 persons reverted to a positive Ca balance. Patients receiving total parenteral nutrition may develop metabolic bone disease characterized by osteomalacia, hypercalcemia, hypercalciuria and a negative Ca balance. This may be caused by defective mineralization and increased bone resorption induced by vitamin D, its metabolites or another unrecognized factor.