PTU-123 Prevalence of metabolic bone disease in hpn patients and progression of bone mineral density

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The prevalence of metabolic bone disease (MBD) in Type 3 Intestinal Failure (IF) has been reported at 84% (1) but it is unclear if long term home parenteral nutrition (HPN) is associated with a consistent decline in bone mineral density (2). The aim of this study was to evaluate the prevalence of MBD and the progression of BMD in a large cohort of patients with CIF managed at a national referral centre.


The prevalence of MBD in patients requiring HPN was evaluated retrospectively from a maintained database at a national U.K. referral unit in 2016. BMD was measured using DEXA scan and WHO criteria were used to categorise patients into normal (T score −1 and above), osteopenia (T score between −1 and −2.5), and osteoporosis (T score −2.5 and below). BMD progression was assessed by reviewing follow up DEXA scan results. Patient demographics along with HPN requirements and underlying disease were recorded.


140 patients (mean age 54 years; 87 female)) with CIF had a DEXA scan performed. 85.7% patients were dependent on PN for calories and 11.4% were fluid dependent only.


106 (75.7%) patients had a diagnosis of MBD (58 (41%)) osteoporosis; 48 (34.3%) osteopenia). 34 (24.3%) patients had a normal BMD.


47 patients had follow up of BMD with a 2nd DEXA bone scan (time between DEXA scans, mean=2.4 years, min=1, max=5). Deterioration in BMD was demonstrated in 12 (26%) patients with change in WHO classification (7=osteoporosis from osteopenia; 5=osteopenia from normal). 34 (72%) showed no change in classification (osteoporosis n=21, osteopenia n=11, normal n=2). Only 1 (2%) patient had improvement in classification from osteoporosis to osteopenia.


Aetiology of IF was classified into intestinal dysmotility (20%); post-operative surgical complications (26.4%); Crohn’s disease (32.9%); ischaemia (18.6%) and malignancy (2.1%). Prevalence of MBD differed between groups, with Crohn’s patients demonstrating the highest prevalence of MBD, 98% (52% osteoporosis, 46% osteopenia).


We report a MBD prevalence in patients with CIF of 75.7%, comparable to other series),1 with a quarter of patients demonstrating a decline in T score. These data support the need for surveillance and treatment of MBD in patients needing HPN.2

Disclosure of Interest

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