Metabolic Bone Disease in Children with Intestinal Failure and Long-Term Parenteral Nutrition: A Systematic Review

Metabolic bone disease (MBD) is a possible complication of intestinal failure (IF), with a multi-factorial pathogenesis. The reduction of bone density (BMD) may be radiologically evident before manifestation of clinical signs (bone pain, vertebral compression, and fractures). Diagnosis relies on dua...

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Bibliographic Details
Published in:Nutrients 2022-02, Vol.14 (5), p.995
Main Authors: Gatti, Simona, Quattrini, Sara, Palpacelli, Alessandra, Catassi, Giulia N, Lionetti, Maria Elena, Catassi, Carlo
Format: Article
Language:English
Subjects:
Bone density
bone disease
Bone diseases
Bone Diseases, Metabolic - diagnosis
Bone Diseases, Metabolic - epidemiology
Bone Diseases, Metabolic - etiology
Bone mineral density
Child
Children
Clinical trials
Compression
Cross-Sectional Studies
Data collection
Dual energy X-ray absorptiometry
DXA
Etiology
Fractures
Humans
Inflammatory bowel disease
Intestinal Failure
Intestine
Metabolism
Nutrition
Osteoporosis
Pain
Parenteral nutrition
Parenteral Nutrition - adverse effects
Prospective Studies
Retrospective Studies
Rickets
Risk analysis
Risk factors
short bowel
Systematic Review
Vitamin D
Vitamin deficiency
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Summary:Metabolic bone disease (MBD) is a possible complication of intestinal failure (IF), with a multi-factorial pathogenesis. The reduction of bone density (BMD) may be radiologically evident before manifestation of clinical signs (bone pain, vertebral compression, and fractures). Diagnosis relies on dual-energy X-ray absorptiometry (DXA). Incidence and evolution of MBD are not homogeneously reported in children. The aim of this systematic review was to define the prevalence of MBD in IF children and to describe risk factors for its development. A comprehensive search of electronic bibliographic databases up to December 2021 was conducted. Randomized controlled trials; observational, cross-sectional, and retrospective studies; and case series published between 1970 and 2021 were included. Twenty observational studies (six case-control) were identified and mostly reported definitions of MBD based on DXA parameters. Although the prevalence and definition of MBD was largely heterogeneous, low BMD was found in up to 45% of IF children and correlated with age, growth failure, and specific IF etiologies. Data demonstrate that long-term follow-up with repeated DXA and calcium balance assessment is warranted in IF children even when PN dependence is resolved. Etiology and outcomes of MBD will be better defined by longitudinal prospective studies focused on prognosis and therapeutic perspectives.
ISSN:2072-6643
2072-6643
DOI:10.3390/nu14050995