Fetal and neonatal bone health: update on bone growth and manifestations in health and disease

Abstract

The neonatal period is classically described as the first 28 days of life, but owing to the fact that changes in skeletal tissue occur at a somewhat slower pace than those of other organ systems, events of the first few months are considered herein. Neonatal bone health is a problem of growing interest and concern because of the increasing recognition of its impact upon childhood, adolescent and even adult bone health. Osteoporosis in adulthood often has its roots in childhood and some forms may be prevented by proper attention to neonatal and childhood bone health. The premature infant likely suffers lifelong decreased bone mineral density as a result of its early birth and lack of adequate mineral stores that are typically present in full-term infants. Adequate embryogenesis, growth and development of the skeletal system are multifactorial and under the influence of a host of genes, growth factors and enzymes. The evaluation of skeletal dysplasias and their recognition are beyond the scope of this paper and will not be considered in this discussion. Here the focus will be on the adequacy of mineralization and metabolic aspects of the growth and development of the fetal and neonatal skeleton, the effect of birth, both preterm and term, maternal illness and health as well as infant diseases.

Radiology of Osteogenesis Imperfecta, Rickets and Other Bony Fragility States

“…Bone shape, size, proportions and other factors are also considered. In the context of bony fragility, a distinction can be made between osteopaenic (and osteoporotic) states, characterised by a reduction in the quantity of bone tissue (the thickness of the cortex and the number and thickness of the trabeculae) and osteomalacic states, characterised by the reduced mineralisation of bone tissue (with preservation of quantity), usually related to reduced serum mineral ion concentrations [7] . OI exemplifies osteopaenia because cortices and trabeculae may appear thin, but the radiographic densities of these structures are preserved.…”

“…This is a misleading oversimplification because it occurs equally in children, with only the absence of growth plate changes differentiating adult manifestations of vitamin D deficiency. Osteomalacia refers to the impaired mineralisation of osteoid during bone formation and remodelling [7] . It reflects the reduced availability of mineral ions for the formation of hydroxyapatite crystals.…”

53: Is Caffeine a Risk Factor for Osteopenia of Prematurity?

“…This is most prominent in areas where metabolic activity has been already significant and osteoclasts are readily available for the work of resorbing bone in the metaphysis. It is unknown whether demineralization after birth and physiological osteopenia of prematurity are secondary or primary, however, primary osteopenia is unusual in neonates (Done, 2012). Some evidence indicates that the placenta has a role in BMC because 25 OH Vitamin D is converted to 1,25-dihydrocholecalciferol in the placenta, which is important in the transfer of phosphate across the placenta to the fetus (Arash & Holick, 2013).…”

“…Some forms may be prevented by proper attention to neonatal and childhood bone health. A premature infant likely suffers lifelong decreased bone mineral density as a result of his or her early birth and the lack of adequate mineral stores that are typically present in full-term infants (Done, 2012). Caffeine is now one of the most commonly prescribed drugs in the NICU to treat apnea of prematurity.…”

“…In one study of 865 VLBW preterm infants, infants fed un-supplemented human milk had elevated serum alkaline phosphatase activity, indicating stimulation of bone resorption to normalize the serum Ca concentration (Brooke, Baker Lucas, Bishop, Morley, 1989). Those who have severe liver problems because of cholestasis, often a result of parenteral hyper-alimentation or biliary atresia are at greater risk for osteopenia (Done, 2012).…”