BONE-MINERAL CONTENT IN INFANTS AND CHILDREN WITH CHRONIC CHOLESTATICLIVER-DISEASE

Objective. To assess bone mineral content (BMC) status and serum vitam in D metabolite levels of infants and children with chronic cholestati c liver disease. To determine if severity of bone disease in these pat ients correlates with serum vitamin D metabolite levels. Methodology. We measured radial BMC with the use of a single-beam photon absorptiom eter and serum vitamin D metabolite levels in 56 patients with chronic cholestasis seen at our institution from 1985 through 1991. Patients were divided into two groups according to age. Results. In group 1 (n = 37; age 2 to 22 months), decreased levels of BMC were seen as early as the first few months of life, with sharp decline observed with incr easing age (approaching 3 to 5 standard deviations [SD] below the mean , P < .0003). Older patients (group 2, n = 19; age 2 to 20 years) had BMC values which clustered between 2 and 4 SD below the mean throughou t the age range. Although a downward trend also was noted with increas ing age, this was not statistically significant. Despite correction fo r weight-age or height-age, BMC was decreased in most of these patient s. No correlation between severity of osteopenia and serum levels of 2 5(OH)-vitamin D and 1,25(OH)2-vitamin D was observed in either infants or older children. Conclusions. Decreased bone mineralization, as a c omplication of chronic cholestatic conditions, is a disease process th at begins early in infancy, rapidly worsens with increasing age and he patic dysfunction, and remains relatively stable in children with more stable liver disease.