Long-Term Follow-up of Hypophosphatemic Bone Disease Associated With Elemental Formula Use: Sustained Correction of Bone Disease After Formula Change or Phosphate Supplementation

2020 ◽  
Vol 59 (12) ◽  
pp. 1080-1085
Author(s):  
Abigail S. Eswarakumar ◽  
Nina S. Ma ◽  
Leanne M. Ward ◽  
Philippe Backeljauw ◽  
Halley Wasserman ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Bone Disease ◽  
Serum Alkaline Phosphatase ◽  
Serum Phosphorus ◽  
Phosphorus Concentration ◽  
Disease Extent ◽  
Elemental Formula ◽  
Radiology Reports ◽  
Phosphate Supplementation

In this article, we describe the long-term outcomes of children who were previously reported to have developed hypophosphatemic bone disease in association with elemental formula use. An extended chart review allowed for an updated report of 34 children with regard to severity/duration of bone disease, extent of recovery, and time to correction using radiology reports and biochemical data. After implementation of formula change and/or phosphate supplementation, we found that serum phosphorus concentration increased and serum alkaline phosphatase activity decreased in all patients, normalizing by 6.6 ± 4.0 (mean ± SD) months following diagnosis. The decrease in serum alkaline phosphatase from diagnosis to the time of correction was moderately correlated with the concurrent increase in serum phosphorus ( R = 0.48, P < .05). Age at diagnosis significantly correlated with time to resolution ( R = 0.51, P = .01). This study supports the earlier report that bone disease associated with hypophosphatemia during elemental formula use responds to formula change and/or phosphate supplementation.

Increased serum alkaline phosphatase as a predictor of long-term mortality after stroke

Neurology ◽  
2010 ◽  
Vol 75 (22) ◽  
pp. 1995-2002 ◽  
Author(s):  
W.- S. Ryu ◽  
S.- H. Lee ◽  
C. K. Kim ◽  
B. J. Kim ◽  
B.- W. Yoon
Keyword(s):  
Alkaline Phosphatase ◽  
Serum Alkaline Phosphatase ◽  
Long Term Mortality

Skeletal Blood Flow in Paget's Disease of Bone and its Response to Calcitonin Therapy

1978 ◽  
Vol 54 (1) ◽  
pp. 69-74 ◽  
Author(s):  
R. Wootton ◽  
J. Reeve ◽  
E. Spellacy ◽  
M. Tellez-Yudilevich
Keyword(s):  
Alkaline Phosphatase ◽  
Blood Flow ◽  
Serum Alkaline Phosphatase ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Short Term ◽  
Urinary Hydroxyproline ◽  
Rapid Fall ◽  
Hydroxyproline Excretion

1. Blood flow to the skeleton was measured by the 18F clearance method of Wootton, Reeve & Veall (1976) in 24 patients with untreated Paget's disease. In every patient but one, resting skeletal blood flow was increased. There was a significant positive correlation between skeletal blood flow and serum alkaline phosphatase and between skeletal blood flow and urinary total hydroxyproline excretion. 2. Fourteen patients were re-studied after they had received short-term (7 days or less) or long-term (7 weeks or more) calcitonin. Skeletal blood flow, alkaline phosphatase and urinary hydroxyproline excretion fell towards normal in every case. There was some evidence from the short-term studies that calcitonin produced a more rapid fall in skeletal blood flow than in alkaline phosphatase. 3. Glomerular filtration rate appeared to increase transiently in response to calcitonin.

Rickets Associated With Long-Term Anticonvulsant Therapy in a Pediatric Outpatient Population

PEDIATRICS ◽  
1975 ◽  
Vol 56 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Carl J. Crosley ◽  
Claire Chee ◽  
Peter H. Berman
Keyword(s):  
Alkaline Phosphatase ◽  
Alkaline Phosphatase Activity ◽  
Serum Alkaline Phosphatase ◽  
Pediatric Population ◽  
Anticonvulsant Therapy ◽  
Control Population ◽  
Serum Alkaline Phosphatase Activity ◽  
Calcium And Phosphorus ◽  
And Control

Over a 12-month period, an ambulatory pediatric population receiving long-term anticonvulsants was surveyed for the presence of biochemical and radiologic rickets. There were 74 treated children and 95 matched controls. Elevations of serum alkaline phosphatase activity occurred in 31 of the 74 (42%) treated children (23 of 47 children between 2 and 10 years and 8 of 21 children between 10 and 16 years). This frequency of abnormal values was significantly greater than that which occurred in our control population. Calcium and phosphorus abnormalities were minimal in both treated and control populations. Radiologic rickets occurred in 6 of the 74 (8%) of the treated children and in none of the control population. Neither the severity of the rickets nor the degree of hyperalkaline phosphatasemia were correlated with age of the patient, duration, and/or dose of anticonvulsant therapy.

Serum Gamma-Glutamyl Transpeptidase Activity as an Indicator of Disease of Liver, Pancreas, or Bone

1972 ◽  
Vol 18 (4) ◽  
pp. 358-362 ◽  
Author(s):  
Gifford Lum ◽  
S Raymond Gambino
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Viral Hepatitis ◽  
Bone Disease ◽  
Leucine Aminopeptidase ◽  
Serum Alkaline Phosphatase ◽  
Metastatic Carcinoma ◽  
Gamma Glutamyl Transpeptidase ◽  
Serum Alkaline Phosphatase Activity ◽  
Glutamyl Transpeptidase

Abstract Serum γ-glutamyl transpeptidase (GGT), leucine aminopeptidase, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase activities were assayed in controls and in patients with liver, pancreatic, or bone disease. GGT activity was above normal in all forms of liver disease studied (viral hepatitis, cirrhosis, cholecystitis, metastatic carcinoma to liver, pancreatic carcinoma, liver granuloma, and acute pancreatitis). GGT more sensitively indicated hepatic disease than did alkaline phosphatase, much more so than did leucine aminopeptidase. GGT was disproportionately more active in relation to the transaminases in cases of intraor extrahepatic biliary obstruction; the reverse was true in cases of viral hepatitis. GGT activity was normal in children, adolescents, and pregnant women, and in cases of bone disease and renal failure. Kinetic measurement of GGT activity offers a simple, sensitive, and direct means for distinguishing whether bone or liver is the source of increased serum alkaline phosphatase activity. Activity was highest in obstructive liver disease.

Abnormal Bone Mineral Metabolism after Long-Term Anticonvulsant Treatment

1994 ◽  
Vol 28 (1) ◽  
pp. 47-48 ◽  
Author(s):  
Christopher P. Alderman ◽  
Catherine L. Hill
Keyword(s):  
Alkaline Phosphatase ◽  
Serum Concentration ◽  
Bone Mineral ◽  
Serum Alkaline Phosphatase ◽  
Mineral Metabolism ◽  
Bone Mineral Metabolism ◽  
Hepatic Microsomal Enzyme ◽  
Grand Mal ◽  
Anticonvulsant Treatment

OBJECTIVE: To present a case of anticonvulsant-induced disturbances of bone mineral metabolism associated with long-term phenytoin treatment. CASE SUMMARY: An 87-year-old woman was hospitalized with generalized acroparesthesia. Her medical history was significant for grand mal epilepsy, which had been treated with phenytoin for more than ten years. On admission she was found to be hypocalcemic, and her alkaline phosphatase concentration was markedly elevated. DISCUSSION: Further investigations revealed that the patient's serum concentration of 25-hydroxycalciferol was well below the expected range. Phenytoin treatment was withdrawn, and calcitriol supplementation commenced. Ten weeks later she was normocalcemic, and the calcitriol dosage was reduced. Radiologic investigations at this time revealed an ununited hip fracture, as well as widespread evidence of bone demineralization. CONCLUSIONS: Minor elevations of liver enzymes observed in association with anticonvulsant treatment may reflect hepatic microsomal enzyme induction. Marked elevation of serum alkaline phosphatase, particularly when seen in concert with hypocalcemia, may be markers of anticonvulsant-induced bone disease. Under these circumstances, further radiologic investigations and measurement of the vitamin D serum concentration should be undertaken.

Technetium-99m Polyphosphate Bone Image for Early Detection of Skeletal Metastasis

1974 ◽  
Vol 13 (04) ◽  
pp. 330-340
Author(s):  
W. H. Blahd ◽  
G. T. Krishnamurthy
Keyword(s):  
Alkaline Phosphatase ◽  
Bone Disease ◽  
Serum Alkaline Phosphatase ◽  
Skeletal Metastasis ◽  
Normal Serum ◽  
Metastatic Bone Disease ◽  
Bone Lesions ◽  
Elevated Alkaline Phosphatase ◽  
Technetium 99M ◽  
Calcium Phosphorus

SummaryTechnetium 99m-polyphosphate bone images are correlated with bone roentgenography, and serum calcium, phosphorus and alkaline phosphatase in 91 patients with suspected bone metastasis. Technetium polyphosphate bone images are the most sensitive and serum level of calcium and phosphorus are the least sensitive indicator of bone lesions. Bone roentgenography is not as sensitive as technetium polyphosphate images. Abnormal bone images with normal or abnormal bone roentenography associated with increased alkaline phosphatase in the absence of liver metastasis are highly suggestive of metastatic bone disease. Abnormal bone images adjoining the joints, associated with normal serum alkaline phosphatase and abnormal joint roentgenography suggest arthritis. It is recommended that technetium 99m-labelled phosphate bone images are considered to be the diagnostic procedure of choice to detect skeletal lesions. Polyphosphate bone images are highly sensitive, with the combination of elevated alkaline phosphatase they become relatively more specific for a metastatic bone disease.

Recurrent Transient Hyperphosphatasemia of Infancy in an Adult

1992 ◽  
Vol 38 (9) ◽  
pp. 1913-1915 ◽  
Author(s):  
D Onica ◽  
J Torssander ◽  
L Waldenlind
Keyword(s):  
Immune Deficiency ◽  
Alkaline Phosphatase ◽  
Bone Disease ◽  
Serum Alkaline Phosphatase ◽  
Electrophoretic Pattern ◽  
Reference Limit ◽  
Upper Reference Limit

Abstract We report a case of recurrent transient hyperphosphatasemia in a 29-year-old man with immune deficiency. He had serum alkaline phosphatase (ALP; EC 3.1.3.1) activity 16.9- and 4.8-fold greater than the upper reference limit on two occasions; the activity returned to normal within 2 months on the first and within 1 month on the second. On both occasions we observed the typical electrophoretic pattern for ALP isoenzymes seen in transient hyperphosphatasemia of infancy. We noted no evidence of liver or bone disease. Recognition of the occurrence of transient hyperphosphatasemia of infancy in adults, although rare (it is the fifth case reported), seems as important as in children so that unnecessary extensive investigations are avoided.

Renal Hypophosphatemic Rickets: Growth Acceleration After Long-Term Treatment with 1,25-Dihydroxyvitamin-D3

PEDIATRICS ◽  
1980 ◽  
Vol 66 (3) ◽  
pp. 445-454 ◽  
Author(s):  
James C. M. Chan ◽  
Robert D. Lovinger ◽  
Peter Mamunes
Keyword(s):  
Serum Alkaline Phosphatase ◽  
Bone Age ◽  
Term Treatment ◽  
Hypophosphatemic Rickets ◽  
Phosphorus Concentration ◽  
Calcium Excretion ◽  
Dihydroxyvitamin D3 ◽  
1,25 Dihydroxyvitamin D3 ◽  
Long Term Treatment

Treatment with 1,25-dihydroxyvitamin-D3 and phosphorus supplementation for as long as 48 months was evaluated in six patients with renal hypophosphatemic rickets. Previous phosphorus supplementation of 1,800 to 4,000 mg/sq m of body surface area per day was continued while 1,25-dihydroxyvitamin-D3 at 17 to 80 ng/kg of body weight per day was given orally in place of vitamin-D2. The serum calcium concentration stayed within the normal range in the majority of patients, while the serum phosphorus concentration rose from 2.5 ± 0.4 to 3.4 ± 1.2 mg/100 ml after one month (P &lt; .01). With rare exceptions, serum alkaline phosphatase and parathyroid hormone concentrations stayed normal throughout the study. Healing of rickets was demonstrated by radiography. In five patients, growth velocity was evaluated for 12 months before and after therapy. Growth accelerations were 123% to 235% of that expected for changes in chronologic age and 114% to 200% expected for changes in bone age after therapy. Orally administered, 1,25-dihydroxyvitamin-D3 increased renal calcium excretion and calcium retention was achieved by virtue of the decreased fecal calcium loss. In contrast, 1,25-dihydroxyvitamin-D3, even at doses up to 4 µg/day (80 ng/kg/day) did not significantly alter renal phosphaturia. The phosphorus retention was therefore achieved as the result of the decreased fecal phosphate excretion. The absence of hypercalcemia even at high doses of 1,25-dihydroxyvitamin-D3 and the enhanced linear growth support the long-term therapeutic value of 1,25-dihydroxyvitamin-D3 in renal hypophosphatemic rickets.

Rickets Associated With Long-Term Anticonvulsant Therapy

PEDIATRICS ◽  
1977 ◽  
Vol 60 (2) ◽  
pp. 261-262
Author(s):  
Francesca Severi ◽  
Maria Clara Gasparoni ◽  
Carla Martini
Keyword(s):  
Alkaline Phosphatase ◽  
Serum Alkaline Phosphatase ◽  
Anticonvulsant Therapy ◽  
Control Population ◽  
Calcium And Phosphorus ◽  
Phosphorus Levels ◽  
At Home

The study presented by Crosley et al. in the July 1975 issue of Pediatrics (page 52) is the first dealing with noninstitutionalized children. A significantly higher value of serum alkaline phosphatase was observed in treated children than in the control population, while calcium and phosphorus abnormalities were minimal in both groups. We concluded a study on the serum alkaline phosphatase, calcium, and phosphorus levels in noninstitutionalized children, including 50 who were from 3 to 14 years old and who were receiving long-term anticonvulsant therapy (either diphenylhydantoin, phenobarbital, or both for more than 12 months) and 57 age-matched controls, all living at home.

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