THE OSTEODYSTROPHY OF PROLONGED OBSTRUCTIVE LIVER DISEASE IN CHILDHOOD

Abstract

Ten infants with obstructive jaundice who developed varying degrees of metabolic bone disease were studied biochemically and radiologically. Mild rickets was present in 7, and 3 others with severe bone disease developed widespread skeletal demineralization and multiple fractures. The intake of vitamin D was apparently loosely related to the severity of the osteodystrophy. The latter was closely linked to the serum Pi and the Ca .times. phosphate product. The serum Ca was directly related to the infant''s gestational maturity, hypocalcemia being present in those born before 35 wk. Pathogenetic factors probably included reactive hyperparathyroidism and nutritional deprivation associated with preterm delivery. Five of the infants who had biliary atresia developed radiological evidence of osteoporosis from about 12 mo. of age. This may be related to protracted Ca malabsorption, but its true nature remains to be elucidated.