Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences

Abstract

Metabolic bone disease of prematurity (MBDP) is characterised by skeletal demineralisation, and in severe cases it can result in fragility fractures of long bones and ribs during routine handling. MBDP arises from prenatal and postnatal factors. Infants who are born preterm are deprived of fetal mineral accumulation, 80% of which occurs in the third trimester. Postnatally, it is difficult to maintain a comparable intake of minerals, and medications, such as corticosteroids and diuretic therapy, lead to bone resorption. With improvements in neonatal care and nutrition, the incidence of MBDP in preterm infants appears to have decreased, although the recent practice of administering phosphate supplements alone will result in secondary hyperparathyroidism and associated bone loss, worsening MBDP. Postnatal immobilisation and loss of placental supply of oestrogen also contribute to skeletal demineralisation. There is no single diagnostic or screening test for MBDP, with pitfalls existing for most radiological and biochemical investigations. By reviewing the pathophysiology of calcium and phosphate homeostasis, one can establish that plasma parathyroid hormone is important in determining the aetiology of MBDP – primarily calcipaenia or phosphopaenia. This will then direct treatment with the appropriate supplements while considering optimal physiological calcium to phosphate ratios.

Neonatal Bone Disorders

“…As most materno-fetal calcium transfer during pregnancy occurs during the last trimester, babies born <28 weeks gestational age are particularly predisposed to this condition. A comprehensive review of the diagnosis and management of this condition has been published recently (37).…”

Perinatal Femoral Fracture: A Ten-Year Observational Case Series Study

“…Interestingly, 4/8 (50%) of our patients were premature compared with 11/34 (32%) in the literature [ 1 , 4 , 6 , 13 ]. Preterm birth could be associated with a higher risk of perinatal fracture; around 80% of bone mineralization occurs during the third trimester and, therefore, premature newborns have an increased risk of osteopenia [ 3 , 18 , 19 ]. Other metabolic bone risk factors associated with this injury include osteogenesis imperfecta and disuse osteoporosis following prolonged immobilization [ 4 , 6 ].…”

The echographic characteristics of structural and functional development of organs and systems in children born with low birth weight, very low birth weight and extremely low birth weight

“…Все эти факторы ведут к нарушению в первую очередь кальциево-фосфорного обмена в организме ребенка, характеризующемуся таким состоянием, как остеопения недоношенных. Изменение уровня кальция и фосфора крови, в свою очередь, приводит к компенсаторному повышению уровня паратгормона, таким образом, отмечается вторичный гиперпаратиреоидизм [46]. Данное состояние только ухудшает течение остеопении.…”