Metabolic bone disease of prematurity

Stacy E Rustico, Andrew C Calabria, Samuel J Garber, Stacy E Rustico, Andrew C Calabria, Samuel J Garber

Abstract

Metabolic bone disease (MBD) of prematurity remains a significant problem for preterm, chronically ill neonates. The definition and recommendations for screening and treatment of MBD vary in the literature. A recent American Academy of Pediatrics Consensus Statement may help close the gap in institutional variation, but evidence based practice guidelines remain obscure due to lack of normative data and clinical trials for preterm infants. This review highlights mineral homeostasis physiology, current recommendations in screening and monitoring, prevention and treatment strategies, and an added perspective of a bone health team serving a high volume referral neonatal intensive care center.

Keywords: ALP, Alkaline phosphatase; ELBW, Extremely low birth weight; MBD, Metabolic bone disease; Metabolic bone disease; Osteopenia; PTH, Parathyroid hormone; Prematurity; Rickets; TRP, Tubular reabsorption of phosphate; VLBW, Very low birth weight.

Figures

Figure 1
Figure 1
Radiographs – A) Normal mineralization of the proximal humerus in a six month old former full term infant; growth plate formation is shown (arrow), B) Early demineralization in the humerus of a six month old former ELBW preterm infant with periosteal reaction (arrow), C) and D) Severe demineralization with features of rickets including cupping and fraying of metaphyses, healing fracture (arrow), and cortical thinning. Images are courtesy of Dr. Janet Reid, The Children's Hospital of Philadelphia.
Figure 2
Figure 2
Algorithm for screening and monitoring MBD.

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