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The Role of Nutrition for Bone Health in Cystic Fibrosis

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Part of the book series: Nutrition and Health ((NH))

Abstract

Cystic fibrosis (CF) is a common genetic disorder in the United States, affecting approx 1 in 3200 white and 1 in 15,000 black live births (1). This disease results in abnormal sodium and chloride transport resulting from mutations in the CF transmembrane conductance regulator (CFTR) (2). Mutations in the CFTR alter the osmolarity of body secretions, resulting in lung and gastrointestinal (GI) complications. Blocked bronchial airways, lung infections, and GI disturbances involving maldigestion and malabsorption are common consequences of CF.

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References

  1. Hamosh A, Fitz-Simmons SC, Macek M Jr, Knowles MR, Rosenstein BJ, Cutting GR. Comparison of the clinical manifestations of cystic fibrosis in black and white patients. J Pediatr 1998; 132:255–259.

    Article  PubMed  CAS  Google Scholar 

  2. Greger R, Schreiber R, Mall M, et al. Cystic fibrosis and CFTR. Pflugers Arch 2001; 443(suppl 1):S3–S7.

    PubMed  CAS  Google Scholar 

  3. Orenstein DM, Rosenstein BJ, Stern RC. Cystic Fibrosis: Medical Care. Lippincott, Williams and Wilkins, Philadelphia, 2000.

    Google Scholar 

  4. Conway SP, Morton AM, Oldroyd B, et al. Osteoporosis and osteopenia in adults and adolescents with cystic fibrosis: prevalence and associated factors. Thorax 2000; 55:798–804.

    Article  PubMed  CAS  Google Scholar 

  5. Haworth CS, Selby PL, Webb AK, et al. Low bone mineral density in adults with cystic fibrosis. Thorax 1999; 54:961–967.

    Article  PubMed  CAS  Google Scholar 

  6. Laursen EM, Molgaard C, Michaelsen KF, Koch C, Muller J. Bone mineral status in 134 patients with cystic fibrosis. Arch Dis Child 1999; 81:235–240.

    Article  PubMed  CAS  Google Scholar 

  7. Donovan DSJ, Papadopoulos A, Staron RB, et al. Bone mass and vitamin D deficiency in adults with advanced cystic fibrosis lung disease. Am J Respir Crit Care Med 1998; 157:1892–1899.

    PubMed  Google Scholar 

  8. Bailey DA, McKay HA, Mirwald RL, Crocker PR, Faulkner RA. A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the University of Saskatchewan Bone Mineral Accrual Study. J Bone Miner Res 1999; 14:1672–1679.

    Article  PubMed  CAS  Google Scholar 

  9. Heaney RP, Abrams S, Dawson-Hughes B, et al. Peak bone mass. Osteopor Int 2000; 11:985–1009.

    Article  CAS  Google Scholar 

  10. Cystic Fibrosis Foundation. Patient Registry 1999 Annual Report. Cystic Fibrosis Foundation, Bethesda, MD, 2000.

    Google Scholar 

  11. Corey M, McLaughlin FJ, Williams M, Levison H. A comparison of survival, growth, and pulmonary function in patients with cystic fibrosis in Boston and Toronto. J Clin Epidemiol 1988; 41:583–591.

    Article  PubMed  CAS  Google Scholar 

  12. Landon C, Rosenfeld RG. Short stature and pubertal delay in cystic fibrosis. Pediatrician 1987; 14:253–260.

    PubMed  CAS  Google Scholar 

  13. Johannesson M, Landgren BM, Csemiczky G, Hjelte L, Gottlieb C. Female patients with cystic fibrosis suffer from reproductive endocrinological disorders despite good clinical status. Hum Reprod 1998; 13:2092–2097.

    Article  PubMed  CAS  Google Scholar 

  14. Stead RJ, Hodson ME, Batten JC, Adams J, Jacobs HS. Amenorrhoea in cystic fibrosis. Clin Endocrinol (Oxf) 1987; 26:187–195.

    Article  CAS  Google Scholar 

  15. Moshang T, Holsclaw DS Jr. Menarchal determinants in cystic fibrosis. Am J Dis Child 1980; 134:1139–1142.

    PubMed  CAS  Google Scholar 

  16. Hahn TJ, Squires AE, Halstead LR, Strominger DB. Reduced serum 25-hydroxyvitamin D concentration and disordered mineral metabolism in patients with cystic fibrosis. J Pediatr 1979; 94:38–42.

    Article  PubMed  CAS  Google Scholar 

  17. Simopoulos AP, Taussig LM, Murad E, et al. Parathyroid function in patients with cystic fibrosis (abstr). Pediatr Res 1972; 6:95.

    Google Scholar 

  18. Aris RM, Lester GE, Dingman S, Ontjes DA. Altered calcium homeostasis in adults with cystic fibrosis. Osteopor Int 1999; 10:102–108.

    Article  CAS  Google Scholar 

  19. Schulze KJ, O’Brien KO, Germain-Lee EL, Baer DJ, Leonard A, Rosenstein BJ. Efficiency of calcium absorption is not compromised among clinically stable pre-pubertal and pubertal girls with cystic fibrosis. Am J Clin Nutr 2003; 78:110–116.

    PubMed  CAS  Google Scholar 

  20. Hahn TJ, Squires AE, Halstead LR, Strominger DB. Reduced serum 25-hydroxyvitamin D concentration and disordered mineral metabolism in patients with cystic fibrosis. J Pediatr 1979; 94:38–42.

    Article  PubMed  CAS  Google Scholar 

  21. Mortensen LA, Chan GM, Alder SC, Marshall BC. Bone mineral status in prepubertal children with cystic fibrosis. J Pediatr 2000; 136:648–652.

    Article  PubMed  CAS  Google Scholar 

  22. Salamoni F, Roulet M, Gudinchet F, Pilet M, Thiebaud D, Burckhardt P. Bone mineral content in cystic fibrosis patients: correlation with fat-free mass. Arch Dis Child 1996; 74:314–318.

    Article  PubMed  CAS  Google Scholar 

  23. Ionescu AA, Nixon LS, Evans WD, et al. Bone density, body composition, and inflammatory status in cystic fibrosis. Am J Respir Crit Care Med 2000; 162:789–794.

    PubMed  CAS  Google Scholar 

  24. Bohles H, Michalk D. Is there a risk for kidney stone formation in cystic fibrosis? Helv Paediatr Acta 1982; 37:267–272.

    PubMed  CAS  Google Scholar 

  25. Chidekel AS, Dolan TF. Cystic fibrosis and calcium oxalate nephrolithiasis. Yale J Biol Med 1996; 69:317–321.

    PubMed  CAS  Google Scholar 

  26. Turner MA, Goldwater D, David TJ. Oxalate and calcium excretion in cystic fibrosis. Arch Dis Child 2000; 83:244–247.

    Article  PubMed  CAS  Google Scholar 

  27. Bar-Or O, Blimkie CJ, Hay JA, MacDougall JD, Ward DS, Wilson WM. Voluntary dehydration and heat intolerance in cystic fibrosis. Lancet 1992; 339:696–699.

    Article  PubMed  CAS  Google Scholar 

  28. Orenstein DM, Henke KG, Green CG. Heat acclimation in cystic fibrosis. J Appl Physiol 1984; 57:408–412.

    PubMed  CAS  Google Scholar 

  29. Legris GJ, Dearborn D, Stern RC, et al. Sodium space and intravascular volume: dietary sodium effects in cystic fibrosis and healthy adolescent subjects. Pediatrics 1998; 101:48–56.

    Article  PubMed  CAS  Google Scholar 

  30. Waring WW. Current management of cystic fibrosis. Adv Pediatr 1976; 23:401–438.

    PubMed  CAS  Google Scholar 

  31. O’Brien KO, Abrams SA, Stuff JE, Liang LK, Welch TR. Variables related to urinary calcium excretion in young girls. J Pediatr Gastroenterol Nutr 1996; 23:8–12.

    Article  PubMed  Google Scholar 

  32. Matkovic V, Ilich JZ, Andon MB, et al. Urinary calcium, sodium, and bone mass of young females. Am J Clin Nutr 1995; 417–425.

    Google Scholar 

  33. Bronner F, Abrams SA. Urinary and fecal endogenous calcium excretion in the age range of 5–15 y. Am J Clin Nutr 1993; 57:944.

    PubMed  CAS  Google Scholar 

  34. Abrams SA, Sidbury JB, Muenzer J, Esteban NV, Vieira NE, Yergey AL. Stable isotopic measurement of endogenous fecal calcium excretion in children. J Pediatr Gastroenterol Nutr 1991; 12:469–473.

    Article  PubMed  CAS  Google Scholar 

  35. Heaney RP, Recker RR. Determinants of endogenous fecal calcium in healthy women. J Bone Miner Res 1994; 9:1621–1627.

    Article  PubMed  CAS  Google Scholar 

  36. Schulze KJ, O’Brien KO, Germain-Lee EL, Baer DJ, Leonard AL, Rosenstein BJ. Endogenous fecal losses of calcium compromise calcium balance in pancreatic insufficient girls with cystic fibrosis. J Pediatr 2003; 143.

    Google Scholar 

  37. Nicolaidou P, Ladefoged K, Hylander E, Thale M, Jarnum S. Endogenous faecal calcium in chronic malabsorption syndromes and in intestinal lymphangiectasia. Scand J Gastroenterol 1980; 15:587–592.

    Article  PubMed  CAS  Google Scholar 

  38. Hallberg K, Grzegorczyk A, Larson G, Strandvik B. Intestinal permeability in cystic fibrosis in relation to genotype. J Pediatr Gastroenterol Nutr 1997; 25:290–295.

    Article  PubMed  CAS  Google Scholar 

  39. Regan PT, Malagelada JR, DiMagno EP. Duodenal calcium outputs in health and pancreatic disease. Gut 1980; 21:614–618.

    Article  PubMed  CAS  Google Scholar 

  40. Nimmo J, Finlayson ND, Smith AF, Shearman DJ. The production of calcium and magnesium during pancreatic function tests in health and disease. Gut 1970; 11:163–166.

    Article  PubMed  CAS  Google Scholar 

  41. Hansky J. Calcium content of duodenal juice. Am J Dig Dis 1967; 12:725–733.

    Article  PubMed  CAS  Google Scholar 

  42. Weber AM, Roy CC, Chartrand L, et al. Relationship between bile acid malabsorption and pancreatic insufficiency in cystic fibrosis. Gut 1976; 17:295–299.

    Article  PubMed  CAS  Google Scholar 

  43. Walters MP, Littlewood JM. Faecal bile acid and dietary residue excretion in cystic fibrosis: age group variations. J Pediatr Gastroenterol Nutr 1998; 27:296–300.

    Article  PubMed  CAS  Google Scholar 

  44. O’Brien S, Mulcahy H, Fenlon H, et al. Intestinal bile acid malabsorption in cystic fibrosis. Gut 1993; 34:1137–1141.

    Article  PubMed  Google Scholar 

  45. Ars RM, Stephens AR, Ontjes DA, et al. Adverse alterations in bone metabolism are associated with lung infection in adults with cystic fibrosis. Am J Respir Crit Care Med 2000; 162:1674–1678.

    Google Scholar 

  46. Holick MF. Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes 2002; 8:87–98.

    Article  Google Scholar 

  47. Grey V, Lands L, Pall H, Drury D. Monitoring of 25-OH vitamin D levels in children with cystic fibrosis. J Pediatr Gastroenterol Nutr 2000; 30:314–319.

    Article  PubMed  CAS  Google Scholar 

  48. Stead RJ, Houlder S, Agnew J, et al. Vitamin D and parathyroid hormone and bone mineralisation in adults with cystic fibrosis [published erratum appears in Thorax 1988 May; 43(5):424]. Thorax 1988; 43:190–194.

    Article  PubMed  CAS  Google Scholar 

  49. Hanly JG, McKenna MJ, Quigley C, Freaney R, Muldowney FP, Fitz Gerald MX. Hypovitaminosis D and response to supplementation in older patients with cystic fibrosis. Q J Med 1985; 56:377–385.

    PubMed  CAS  Google Scholar 

  50. Friedman HZ, Langman CB, Favus MJ. Vitamin D metabolism and osteomalacia in cystic fibrosis. Gastroenterology 1985; 88:808–813.

    PubMed  CAS  Google Scholar 

  51. Reiter EO, Brugman SM, Pike JW, et al. Vitamin D metabolites in adolescents and young adults with cystic fibrosis: effects of sun and season. J Pediatr 1985; 106:21–26.

    Article  PubMed  CAS  Google Scholar 

  52. Thompson GR, Lewis B, Booth CC. Absorption of vitamin D3–3H in control subjects and patients with intestinal malabsorption. J Clin Invest 1966; 45:94–102.

    Article  PubMed  CAS  Google Scholar 

  53. Lo CW, Paris PW, Clemens TL, Nolan J, Holick MF. Vitamin D absorption in healthy subjects and in patients with intestinal malabsorption syndromes. Am J Clin Nutr 1985; 42:644–649.

    PubMed  CAS  Google Scholar 

  54. Lark RK, Lester GE, Ontjes DA, et al. Diminished and erratic absorption of ergocalciferol in adult cystic fibrosis patients. Am J Clin Nutr 2001; 73:602–606.

    PubMed  CAS  Google Scholar 

  55. Koutkia P, Lu Z, Chen TC, Holick MF. Treatment of vitamin D deficiency due to Crohn’s disease with tanning bed ultraviolet B radiation. Gastroenterology 2001; 121:1485–1488.

    Article  PubMed  CAS  Google Scholar 

  56. Shane E, Silverberg SJ, Donovan D, et al. Osteoporosis in lung transplantation candidates with end-stage pulmonary disease [see comments]. Am J Med 1996; 101:262–269.

    Article  PubMed  CAS  Google Scholar 

  57. Rashid M, Dure P, Andrew M, et al. Prevalence of vitamin K deficiency in cystic fibrosis. Am J Clin Nutr 1999; 70:378–382.

    PubMed  CAS  Google Scholar 

  58. Wilson DC, Rashid M, Dure PR, et al. Treatment of vitamin K deficiency in cystic fibrosis: effectiveness of a daily fat-soluble vitamin combination. J Pediatr 2001; 138:851–855.

    Article  PubMed  CAS  Google Scholar 

  59. Beker LT, Ahrens RA, Fink RJ, et al. Effect of vitamin K1 supplementation on vitamin K status in cystic fibrosis patients. J Pediatr Gastroenterol Nutr 1997; 24:512–517.

    Article  PubMed  CAS  Google Scholar 

  60. Aggett PJ, Comerford JG. Zinc and human health. Nutr Rev 1995; 53:S16–S22.

    PubMed  CAS  Google Scholar 

  61. Castillo-Duran C, Cassorla F. Trace minerals in human growth and development. J Pediatr Endocrinol Metab 1999; 12:589–601.

    Article  Google Scholar 

  62. Cousins RJ. A role of zinc in the regulation of gene expression. Proc Nutr Soc 1998; 57:307–311.

    Article  PubMed  CAS  Google Scholar 

  63. Ghali FE, Steinberg JB, Tunnessen WW. Picture of the month. Acrodermatitis enteropathica-like rash in cystic fibrosis. Arch Pediatr Adolesc Med 1996; 150:99–100.

    Article  PubMed  CAS  Google Scholar 

  64. Hansen RC, Lernen R, Revsin B. Cystic fibrosis manifesting with acrodermatitis enteropathicalike eruption. Association with essential fatty acid and zinc deficiencies. Arch Dermatol 1983; 119:51–55.

    Article  PubMed  CAS  Google Scholar 

  65. Rosenblum JL, Schweitzer J, Kissane JM, Cooper TW. Failure to thrive presenting with an unusual skin rash. J Pediatr 1985; 107:149–153.

    Article  PubMed  CAS  Google Scholar 

  66. Schmidt CP, Tunnessen W. Cystic fibrosis presenting with periorificial dermatitis. J Am Acad Dermatol 1991; 25:896–897.

    Article  PubMed  CAS  Google Scholar 

  67. Darmstadt GL, Schmidt CP, Wechsler DS, Tunnessen WW, Rosenstein BJ. Dermatitis as a presenting sign of cystic fibrosis. Arch Dermatol 1992; 128:1358–1364.

    Article  PubMed  CAS  Google Scholar 

  68. Easley D, Krebs N, Jefferson M, et al. Effect of pancreatic enzymes on zinc absorption in cystic fibrosis. J Pediatr Gastroenterol Nutr 1998; 26:136–139.

    Article  PubMed  CAS  Google Scholar 

  69. Krebs NF, Sontag M, Accurso FJ, Hambidge KM. Low plasma zinc concentrations in young infants with cystic fibrosis. J Pediatr 1998; 133:761–764.

    Article  PubMed  CAS  Google Scholar 

  70. Krebs NF, Westcott JE, Arnold TD, et al. Abnormalities in zinc homeostasis in young infants with cystic fibrosis. Pediatr Res 2000; 48:256–261.

    Article  PubMed  CAS  Google Scholar 

  71. Rucker RB, Kosonen T, Clegg MS, et al. Copper, lysyl oxidase, and extracellular matrix protein cross-linking. Am J Clin Nutr 1998; 67:996S–1002S.

    PubMed  CAS  Google Scholar 

  72. Lowe NM, Lowe NM, Fraser WD, Jackson MJ. Is there a potential therapeutic value of copper and zinc for osteoporosis? Proc Nutr Soc 2002; 61:181–185.

    Article  PubMed  CAS  Google Scholar 

  73. Rodriguez JP, Rios S, Gonzalez M. Modulation of the proliferation and differentiation of human mesenchymal stem cells by copper. J Cell Biochem 2002; 85:92–100.

    Article  PubMed  CAS  Google Scholar 

  74. Percival SS, Kauwell GP, Bowser E, Wagner M. Altered copper status in adult men with cystic fibrosis. J Am Coll Nutr 1999; 18:614–619.

    PubMed  CAS  Google Scholar 

  75. Percival SS, Bowser E, Wagner M. Reduced copper enzyme activities in blood cells of children with cystic fibrosis. Am J Clin Nutr 1995; 62:633–638.

    PubMed  CAS  Google Scholar 

  76. Flohr F, Lutz A, App EM, Matthys H, Reincke M. Bone mineral density and quantitative ultrasound in adults with cystic fibrosis. Eur J Endocrinol 2002; 146:531–536.

    Article  PubMed  CAS  Google Scholar 

  77. Elkin SL, Fairney A, Burnett S, et al. Vertebral deformities and low bone mineral density in adults with cystic fibrosis: a cross-sectional study. Osteopor Int 2001; 12:366–372.

    Article  CAS  Google Scholar 

  78. Henderson RC, Madsen CD. Bone mineral content and body composition in children and young adults with cystic fibrosis. Pediatr Pulmonol 1999; 27:80–84.

    Article  PubMed  CAS  Google Scholar 

  79. Moran CE, Sosa EG, Martinez SM, et al. Bone mineral density in patients with pancreatic insufficiency and steatorrhea. Am J Gastroenterol 1997; 92:867–871.

    PubMed  CAS  Google Scholar 

  80. Rizzoli R, Bonjour JP, Ferrari SL. Osteoporosis, genetics and hormones. J Mol Endocrinol 2001; 26:79–94.

    Article  PubMed  CAS  Google Scholar 

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O’Brien, K.O., Holick, M.F. (2004). The Role of Nutrition for Bone Health in Cystic Fibrosis. In: Holick, M.F., Dawson-Hughes, B. (eds) Nutrition and Bone Health. Nutrition and Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-740-6_34

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  • DOI: https://doi.org/10.1007/978-1-59259-740-6_34

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-451-7

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