Submitted to: Gastroenterology
Publication Type: Review Article
Publication Acceptance Date: 7/7/2009
Publication Date: 11/2/2009
Citation: Nielsen, F.H. 2009. Micronutrients in Parenteral Nutrition: Boron, Silicon, and Fluoride. Gastroenterology. 137:S55-60.
Technical Abstract: Long-term parenteral nutrition (providing nutrients intravenously) is a life-saving treatment for patients with severe malabsorption of nutrients caused by intestinal failure, intestinal trauma (for example, gunshot or stab wounds), and intestinal removal. Metabolic bone disease characterized by mineral loss, abnormal bone formation, and increased risk of bone fracture is a common problem for patients on long-term parenteral nutrition, in spite of efforts to provide all known essential nutrients in adequate and balanced amounts. This suggests that there are some unknown toxicities or deficiencies playing a role in the risk for metabolic bone disease. This review describes findings showing that nutritional amounts of boron and silicon may be beneficial for bone growth and maintenance, and pharmacological amounts of fluoride may help prevent or treat metabolic bone disease, in patients on long-term parenteral nutrition. Hypothesized mechanisms for these beneficial effects are presented. Animal and human studies suggest that providing more than 0.5 mg of boron and 10 mg of silicon and about 3-4 mg of fluoride daily to adults with functioning kidneys receiving long-term parenteral nutrition may be beneficial to bone health. Limited studies indicate that parenteral nutrition solutions do not provide these amounts of boron, silicon and fluoride. Therefore, further studies are warranted to determine whether there are optimal amounts of boron, silicon and fluoride that should be delivered to typical and special population patients receiving long-term parenteral nutrition that would decrease the risk of metabolic bone disease.