Markers of Bone Disease in Children on Parenteral Nutrition

Study Overview
=================
Brief Summary
-----------------
Parenteral nutrition (PN) is the provision of nutrients via the intravenous route. Parenteral nutrition associated metabolic bone disease (MBD) was first described in children in the 1980s. Since then, there has been little to no research into the underlying relationship and as a result, little evidence on which to base clinical care. In adults, MBD is associated with increased fractures. At the Hospital for Sick children in Toronto, an intestinal failure program has been set up since 2003. This is the only intestinal failure program in Canada and receives country wide referrals. Most of the patients have short bowel syndrome (SBS) and require PN for prolonged periods, or for life. About 90% of these patients have MBD, and some have had bone fractures. An understanding of the etiology of MBD would provide information to guide care, and prevent this condition. Funding for this area of research however is challenging because intestinal failure requiring long term PN is a rare condition, accounting for approximately 200 - 300 children in all of Canada. The goal of this study therefore is to gather pilot data on markers of MBD in children on long term PN, and to compare these markers to age and gender matched control patients who are fed by mouth or feeding tube. The information gathered from this study will help us begin to understand what is actually happening in the bones of children on long term PN and will form the basis for future studies and improved clinical care.

Official Title
-----------------
Markers of Parenteral Nutrition (PN) Associated Metabolic Bone Disease in Children on Long-Term PN for Intestinal Failure.

Conditions
-----------------
Metabolic Bone Disease

Participation Criteria
=================
Eligibility Criteria
-----------------
INCLUSION CRITERIA: For Cases on Long-term PN: On PN for ≥ 6 consecutive weeks Willingness to participate in the study For Control Subjects: Healthy as assessed by history and physical exam. Growing normally Are not on medications known to affect bone metabolism eg. Corticosteroids. Never received PN in the past EXCLUSION CRITERIA: For Cases on Long-term PN Patients who are on PN for shorter than 6 weeks Patients on hemodialysis For Control Subjects Subjects who are not able to be matched to a case/subject on long-term PN for age and gender Positive history of fractures Subjects who are unable to participate because of fear of giving blood or unable to come to the hospital for sick children for blood draws.

Ages Eligible for Study
-----------------
Minimum Age: 6 Weeks
Maximum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Subjects on Parenteral Nutrition<br>cases are those on Parenteral Nutrition >6 weeks for intestinal failure. | |
| Subjects not on Parenteral Nutrion<br>Controls are those who have never been on PN but can be fed via a feeding tube | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| serum osteocalcin |  | Over 8 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
pediatric, parenteral nutrition, bone disease, long-term PN