MOSHE SHIKE, M.D.; JOAN E. HARRISON, M.D.; WILLIAM C. STURTRIDGE, M.D., Ph.D.; CHERK S. TAM, M.D., Ph.D.; PETER E. BOBECHKO, M.D.; GLENVILLE JONES, Ph.D.; TIMOTHY M. MURRAY, M.D.; KHURSHEED N. JEEJEEBHOY, M.B., B.S.; Ph.D.
SHIKE M, HARRISON JE, STURTRIDGE WC, TAM CS, BOBECHKO PE, JONES G, et al. Metabolic Bone Disease in Patients Receiving Long-Term Total Parenteral Nutrition. Ann Intern Med. 1980;92:343-350. doi: 10.7326/0003-4819-92-3-343
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Published: Ann Intern Med. 1980;92(3):343-350.
We have prospectively investigated calcium and bone metabolism in 16 patients receiving total parenteral nutrition for periods ranging from 7 to 89 months. In 12 patients, bone biopsies at 6 to 73 months after the start of parenteral nutrition showed osteomalacia. Plasma 25-hydroxyvitamin D levels were normal in all patients. Seven persons developed hypercalcemia, and 10 had hypercalciuria with a negative calcium balance. Serum phosphorus was normal and plasma parathyroid hormone level, normal or decreased. Three patients with the severest form of the disease had vitamin D withdrawn from their solutions. Subsequently, urinary calcium decreased, and serum calcium became normal; two persons reverted to a positive calcium balance. Thus, patients receiving total parenteral nutrition may develop metabolic bone disease characterized by osteomalacia, hypercalcemia, hypercalciuria, and a negative calcium balance. This may be caused by both defective mineralization and increased bone resorption induced by vitamin D, its metabolites, or another unrecognized factor.
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Endocrine and Metabolism, Metabolic Bone Disorders.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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