Metabolic Bone Disease in Long-term Home Parenteral Nutrition

Almost all the patients on home parenteral nutrition (HPN) for benign intestinal failure may have a metabolic bone disease characterized by osteopenia, osteoporosis or osteomalacia. The pathogenesis may be multifactorial. General factors, like aging and postmenopausal status, factors related to the patient’s underlying illness as well as factors due to the HPN may be involved. Epidemiological studies showed that general factors and factors related to the underlying disease play the major pathogenetic role and that long-term HPN is not necessarily associated with a worsening of bone health and in some cases an improvement occurs. Diagnosis and monitoring rely on bone mineral density assessment, on the measurement of serum concentration and urinary excretion of minerals, serum concentrations of vitamin D and PTH, and of biochemical markers of bone turnover. Prevention and treatment are based on life-style and dietary recommendations, treatment of the underlying disease related-factors and on optimisation of vitamin D nutritional status and of the parenteral solution. Intravenous bisphosphonates may prevent further bone demineralisation. Data on treatment with other drugs are anedoctical.