E-Poster Presentation ESA-SRB-ANZBMS 2021

Osteoporosis in patients with intestinal failure at Westmead Hospital: a 20-year single-centre review (#767)

Mawson Wang 1 2 , Cathy Zaccaria 3 , Christian M Girgis 1 2 , Ngai W Cheung 1 2
  1. Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
  2. Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
  3. Intestinal Failure Service, Westmead Hospital, Westmead, NSW, Australia

Background and Aim

Home parenteral nutrition (HPN) provides nutritional support to intestinal failure patients. The aetiology of HPN-related metabolic bone disorders are multifactorial, related to underlying malnutrition and malabsorption, hypercalciuria and aluminium toxicity in earlier preparations1-3.  Recent studies, however have indicated improvement in bone mineral density (BMD) after commencement of HPN, with high prevalence of low BMD at baseline1,4. This 20-year retrospective study reviews baseline DXA characteristics of HPN patients at a single-centre Intestinal Failure Service.

 

Material and Methods

All HPN patients at Westmead Hospital between 2000 and 2020 were retrospectively identified to obtain baseline DXA results and demographics (n=59). After excluding subjects who did not have a baseline DXA scan (GE Lunar) at Westmead Hospital, 22 patients were reviewed.

 

Results

Mean age was 48.6 years (18-84), with 12 males (54.5%) and 10 females (45.5%). 13/21 patients (61.9%) had Vitamin D deficiency (< 50nmol/L) at HPN commencement and 2 (9.1%) were on glucocorticoids. At baseline there was a significant burden of osteopenia (11/22, 50%) and osteoporosis (5/22, 22.7%) in this cohort. The broad categories for HPN indication were prolonged bowel rest (n=8) and inadequate absorption (n=14) related to various pathologies including short gut syndrome, gastroparesis and enterocutaneous fistula. These groups did not differ in their baseline bone density (1.05g/cm2 vs. 1.08g/cm2, p=0.84) or Vitamin D level (48.3nmol/L vs. 47.2nmol/L, p=0.93). Fracture rates could not be assessed. Of the six patients who died from underlying disease processes, baseline BMD T-score ≤-2.5 was not associated with death during the study period (p=0.68).  

 

Conclusion

Metabolic bone disease is common in intestinal failure patients undergoing HPN, compounded by high rates of Vitamin D deficiency. This study highlights the importance of recognising this at-risk group with a need for longterm surveillance protocol with serial DXAs, consideration of Vitamin D replacement and/or early anti-resorptive therapy.  

 

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  2. Klein G. L. (2019). Aluminum toxicity to bone: A multisystem effect?. Osteoporosis and sarcopenia, 5(1), 2–5. https://doi.org/10.1016/j.afos.2019.01.001
  3. Hurley, D. L., & Mc Mahon, M. M. (1990). Long-term parenteral nutrition and metabolic bone disease. Endocrinology and metabolism clinics of North America, 19(1), 113–131.
  4. Pironi, L., Tjellesen, L., De Francesco, A., Pertkiewicz, M., Morselli Labate, A. M., Staun, M., Przedlacki, J., Lezo, A., Orlandoni, P., Pasanisi, F., & ESPEN-home artificial nutrition working group (2004). Bone mineral density in patients on home parenteral nutrition: a follow-up study. Clinical nutrition (Edinburgh, Scotland), 23(6), 1288–1302. https://doi.org/10.1016/j.clnu.2004.04.003