Metabolic bone disease during long-term total parenteral nutrition: Analysis of a patient

A. Rubinacci, L. Cozzaglio, P. Sirtori, F. Bozzetti

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A forty year old female with intestinal non-Hodgkin 's lymphoma and subsequent subtotal jejunectomy, chemotherapy and radiotherapy was studied. She has been on total parenteral nutrition (TPN) for sixty-four months because of a radiation enteritis. She developed a severe metabolic bone disease with negative calcium balance and was confined to bed. Vitamin D2 was withdrawn from the parenteral solution, heparin administration was reduced and calcium and phosphorus infusion was increased. The clinical improvement was dramatic: the bone pain almost completely regressed and the patient started to walk again. The bone metabolism was assessed for twentyfour months. After calcium infusion, PTH was sharply suppressed and during the TPN most of the calcium loss occurred. Plasma aluminum was not high but increased during the study period; bone mineral content decreased. We conclude that vitamin D2 might play a role in metabolic bone disease but is not the only causative factor. Other factors, such as bone status before TPN, heparin administration, impaired and/or modified renal tubular transport of calcium and phosphorus and aluminum accumulation should be considered in the development of metabolic bone disease during TPN.

Original languageEnglish
Pages (from-to)227-234
Number of pages8
JournalRivista Italiana di Nutrizione Parenterale ed Enterale
Issue number3
Publication statusPublished - 1991

ASJC Scopus subject areas

  • Food Science
  • Anatomy
  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics


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