0945 Aluminium exposure and long-term bone health

It has been stated that the “aluminium problem” has been around for 25 years but is still a neglected factor in the management of premature neonates requiring high doses of calcium and phosphate for bone mineralization, children with impaired renal function, and any children requiring parenteral nutrition for prolonged periods. It is known that aluminium contaminates raw materials used to manufacture solutions used for intravenous nutrition, but pharmaceutical manufacturers have only relatively recently had access to technology capable of detecting and measuring the extent of contamination. The American FDA has also entered the arena and in 2004 mandated labeling requirements for aluminium content of all parenteral nutrition components. The FDA also set a limit of exposure at <5mμg/kg/day. However, as shown in a study from California, this limit is far from being achieved. The authors determined daily aluminium intake of all infants and children admitted to the Lucile Packard Children’s Hospital at Stanford in 2006 and who received parenteral nutrition. Almost half the 13 384 patient days were utilized by patients weighing <3kg, and these were also the patients who received the largest amounts of aluminium (30-60 mμg/kg/day). It was only possible to meet the FDA regulation in patients weighing >50kg, leading the authors to conclude that manufacturers must find new methods to reduce aluminium contamination and health care professionals should calculate aluminium loads in patients and make informed decisions when prescribing parenteral nutrition. Is this all just fear-mongering? Not if one takes note of a 15-year follow up of preterm infants in the UK that shows that those who received greater amounts of aluminium in parenteral nutrition solutions as neonates had significantly lower bone mineral content in their hips, and also in their lumbar spine with a concomitant decrease in bone size. These findings might be important in terms of future osteoporosis. This same group of researchers has previously shown aluminium-correlated reduced neurodevelopmental scores in the same cohort.

Read more:
Pediatrics 2009; 124: 1372-9
J Parenter Enteral Nutr 2008; 32: 242-6
Curr Opin Pharmacol 2005; 5: 637-40