Aluminum Is Associated with Low Bone Formation in Patients Receiving Chronic Parenteral Nutrition

doi:10.1059/0003-4819-98-6-910

Aluminum Is Associated with Low Bone Formation in Patients Receiving Chronic Parenteral Nutrition

Seattle, Washington; Los Angeles, California; and Denver, Colorado

Abstract

Patients treated with chronic total parenteral nutrition may develop metabolic bone disease. We evaluated 22 bone biopsy specimens from 16 patients. Compared with those of age- and sex-matched normal controls, these specimens had significantly higher osteoid area and lower total bone area and bone formation rate, as measured by double tetracycline labels. Aluminum was found in specimens from the 14 patients receiving casein hydrolysate but not in the two receiving amino acids as their nitrogen source. The reduced bone formation correlated inversely with the logarithm of the aluminum level. Aluminum was localized to the surface of mineralized bone; tetracycline uptake was absent at those sites. These bone findings are similar to those from aluminum intoxicated patients on hemodialysis. Both groups also have low parathyroid hormone levels. Thus, aluminum appears to be an important pathogenic factor in the osteodystrophy of patients receiving dialysis or total parenteral nutrition.

Article and Author Information

▸From the Veterans Administration Medical Center and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington; the Medical and Research Services, Veterans Administration Wadsworth Medical Center and the Department of Pediatrics and Medicine, UCLA School of Medicine, Los Angeles, California; and the Veterans Administration Medical Center and the Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.
Grant support: in part by U. S. Public Health Service grants RR865 and AM 29926; General Clinical Research Center grant RR-37; and by the Medical Research Service of the Veterans Administration.
▸Requests for reprints should be addressed to Donald J. Sherrard, M.D.; Veterans Administration Medical Center, 443 5 Beacon Avenue, South; Seattle, WA 98108.