{
  "abstract": "Introduction Metabolic Bone Disease (MBD) is a significant complication in children with intestinal failure (IF) on home parenteral nutrition (HPN). 2 Clinical symptoms may not be informative; MBD can be asymptomatic or present with fractures.1 Routine monitoring includes biochemical markers such as serum vitamin D, alkaline phosphatase (ALP), plasma phosphate, calcium, and parathyroid hormone (PTH) levels, while DEXA remains the gold standard for assessing osteoporosis.1 2 Methods This study aimed to assess bone health in children on HPN and identify markers for early intervention. A retrospective review of patients’ clinical records concentrated on DEXA scans, peripheral quantitative CT (pQCT) measurements, and biochemical parameters, using the nearest results to the DEXA scans. Patients with kidney disease and secondary hyperparathyroidism were excluded from the analysis.Results Out of 36 children, 24 had at least one reported DEXA scan (>5 years of age) and were included in the analysis. The median age was 12 years (5–18 years), 45.8% male. The mean BMI z score was –0.39± 0.96 (p=0.29) and height z score –1.96±1.2 (p<0.001).20.8% (5/24) had congenital enteropathies, 75% (18/24) had short bowel syndrome, and 8.3% (2/24) had chronic intestinal pseudo-obstruction. Median HPN duration was 10.53 years (2.94–17.65 years). 44.4% (12/24) had at least one DEXA parameter z score ≤ -2, indicating low bone mineral density (BMD). 13.6% (3/22) had temporarily low mineralization, and 31.8% (7/22) showed temporary changes in spinal morphology due to osteopenia. One patient had fractures. Follow-up scans showed persistent low BMD in 75% (6/8), though bone mineralization and spinal changes improved with regular biochemical monitoring and supplementation.The most consistently reported parameters are shown in table 1.Abstract OC44 Table 1DEXA metrics in paediatric home PN patients Mean z score (n=24) one tail t test (p value) BMD whole body less head for age -4.00 (SD= 9.1) -2.02 (p=0.028) Bone mineral apparent density spine (BMAD) -0.52 (SD= 1.43) -1.72 (p=0.049) pQTC4% Trabecular 0.14 (SD=1.6) 0.41 (p=0.34) Cortical and Trabecular 0.53 (SD=1.55) 1.58 (p=0.06) Only 3/24 patients had elevated PTH levels for >2 months. Adjustments were made to the calcium/phosphate ratio in the PN, or additional calcium supplementation was provided. Vitamin D was routinely supplemented to maintain normal levels (mean 25-OHD3 69.7±23.3). All patients with abnormal scans were reviewed by the paediatric endocrine team and 2/24 have been diagnosed with osteoporosis and started on treatment.Conclusion Children with intestinal failure are at high risk for bone complications, including fractures, even with regular monitoring and supplementation. Low bone mineral density, once diagnosed, has been persistent in our population, though mineralization can improve with vitamin D and calcium supplementation.BMD and BMAD z scores were significantly lower in our cohort, while 4% pQCT cortical/trabecular and cortical z scores did not differ to the general population. DEXA metrics are height-dependent, but pQCT is less affected by patient height, providing a potentially more accurate measure of bone mineral density.Recommendations Regular DEXA and pQCT scans should be standardized for paediatric intestinal failure patients on HPN, especially those with significant BMD reduction or fracture history.References Gatti S, Quattrini S, Palpacelli A, et al. Metabolic bone disease in children with intestinal failure and long-term parenteral nutrition: a systematic review. Nutrients 2022;14(5):995.Tridimas A, Padidela R, Bassett J, et al. Reducing metabolic bone disease burden in intestinal failure children on home parenteral nutrition. JPGN Rep. 2023;4(4):e368.",
  "authors": [
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Afreen Mushtaque"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Raja Padidela"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Rachel Wood"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Timothy James Morris"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Loveday Jago"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Adnaan Kala"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Chai Lee"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Sian Copley"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Andrew Fagbemi"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Maureen Lawson"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s hospital"
      ],
      "name": "Virginia Chatzidaki"
    }
  ],
  "title": "OC44 Assessing bone health in paediatric intestinal failure patients on home parenteral nutrition: a tertiary centre experience",
  "uid": "c139f853-b12f-59fe-96c5-6f188320cf9a"
}