Sequential serum aluminum and urine aluminum: creatinine ratio and tissue aluminum loading in infants with fractures/rickets

• Published in: Pediatrics (Evanston) 1992-05, Vol.89 (5 Pt 1), p.877-881
• Main Authors: Koo, W W, Krug-Wispe, S K, Succop, P, Bendon, R, Kaplan, L A
• Format: Article
• Language: English
• Subjects: Aluminum (Nutrient); Aluminum - adverse effects; Aluminum - metabolism; Aluminum in the body; Antacids - therapeutic use; Bone and Bones - chemistry; Bones; Creatinine - metabolism; Enteral Nutrition; Female; Fractures, Spontaneous - metabolism; Growth; Health aspects; Humans; Infant; Infant Food - adverse effects; Infant formulas; Infant, Low Birth Weight - metabolism; Infant, Newborn; Infants (Premature); Injuries; Male; Parenteral feeding; Parenteral nutrition; Pediatric toxicology; Physiological aspects; Premature infants; Rickets; Rickets - metabolism
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.89.5.877

Aluminum toxicity is associated with the development of bone disorders, including fractures, osteopenia, and osteomalacia. Fifty-one infants with a mean (+/- SEM) birth weight of 1007 +/- 34 g, gestational age of 28.5 +/- 0.3 weeks, and serial radiographic documentation at 3, 6, 9, and 12 months for the presence (n = 16) or absence (n = 35) of fractures and/or rickets were studied at the same intervals to determine the serial changes in serum aluminum concentrations and urine aluminum-creatinine ratios. Autopsy bone samples were used to determine the presence of tissue aluminum. Serum aluminum concentrations from 46 infants were stable and similar between groups, with mean values between 15 and 22 micrograms/L. Urine aluminum-creatinine (micrograms per milligram) ratios from 14 infants were higher in infants with fractures and/or rickets (0.26 +/- 0.06 vs 0.12 +/- 0.04) at onset, and rate of decrease in aluminum-creatinine ratio was faster in infants without fractures and/or rickets. All but three infants were tolerating complete enteral feeding at all sampling points. One infant who received aluminum-containing antacid had marked increase in serum aluminum to 83 micrograms/L while urine aluminum-creatinine ratio increased from 0.09 to a peak of 8.53. Vertebrae from three infants at autopsy (full enteral feeding was tolerated for 37 and 41 days in two infants, respectively) showed aluminum deposition in the zone of provisional calcification and along the newly formed trabecula.