The development of osteopenia is another complication that is common with long-term PN support. The reasons are multifactorial and include relative immobility, inability to provide adequate calcium and phosphorus with solubility limitations, and hypercalciuria. It has also been suggested that the dose of vitamin D in the multivitamin preparation may contribute to bone disease. Excessive vitamin D may suppress parathyroid hormone secretion and directly cause bone resorption. Although aluminum is still present in some intravenous solutions, including calcium gluconate, vitamins, and trace elements, the amounts are much less than those seen with the casein hydrolysates and are not believed to be a significant contributor to the development of metabolic bone disease. Prevention and treatment strategies include maximizing calcium and phosphorus in PN solutions, especially for growing children; providing enteral supplementation of these minerals as feasible; and providing weight-bearing physical therapy if possible.
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