Approach to Metabolic Bone Disease of Prematurity


Vitamin D

How to Cite

Shinde, D. A., Mhaske, P. D. S. N., Misal, D. G. ., & Bhate, D. S. (2020). Approach to Metabolic Bone Disease of Prematurity . VIMS Health Science Journal , 7(4), 147-152.


Neonatal metabolic bone disease (MBD), osteopenia of prematurity (OOP), neonatal rickets or rickets of prematurity, are terms used to describe a reduction in bone mineral content (BMC) of the preterm infant. Although its exact prevalence is difficult to quantify because of the various methods used for screening of infants who are at risk and also because of the difficulty in the interpretation of these results, it has been steadily increasing with the survival of more immature neonates as a result of advances in neonatal care. Pathological conditions which impair placental macro and micronutrients transfer, such as preeclampsia, intrauterine growth restriction, and chorioamnionitis are associated with an increased risk of MBD in preterm infants. There are no specific diagnostic methods for MBD of prematurity. The clinical findings appear late and sometimes the diagnosis is not carried out. Indeed, it is necessary to screen the subjects who are at risk to develop MBD. The prevalence and also the severity of OOP can be reduced by early nutritional intervention. Maintaining a sufficient supply of Ca and P for the growth of VLBW infants’ skeleton is challenging because of their relatively high physiological requirements. Because of the crucial role of mechanical forces on the development of the skeleton, daily exercises such as gentle compression and movements of the limbs are recommended in infants at risk of OOP


Koo WW, Sherman R, Succop P, Krug-Wispe S, Tsang RC, Steichen JJ, Crawford AH, Oestreich AE. Fractures and rickets in very low birth weight infants: conservative management and outcome. J Pediatr Orthop. 1989;9:326–330.

Callenbach JC, Sheehan MB, Abramson SJ, Hall RT. Etiologic factors in rickets of very low-birth-weight infants. J Pediatr. 1981;98:800–805.

Dokos C, Tsakalidis C, Tragiannidis A, Rallis D. Inside the “fragile” infant: pathophysiology, molecular background, risk factors and investigation of neonatal osteopenia. Clin Cases Miner Bone Metab. 2013;10:86–90.

Goulding A, Jones IE, Taylor RW, Williams SM, Manning PJ. Bone mineral density and body composition in boys with distal forearm fractures: a dual-energy x-ray absorptiometry study. J Pediatr. 2001;139:509–515.

Rustico SE, Calabria AC, Garber SJ. Metabolic bone disease of prematurity. Journal of Clinical & Translational Endocrinology. 2014;1:85–91.

Rustico SE, Calabria AC, Garber SJ. Metabolic bone disease of prematurity. J Clin Transl Endocrinol. (2014) 1:85–91. 10.1016/j.jcte.2014.06.004.

Funke S, Morava E, Czak ó M, Vida G, Ertl T, Kosztolányi G. Influence of genetic poymorphisms on bone disease of preterm infants. Ped Res. (2006) 60:607–12. 10.1203/01.pdr.0000242340.45676.5d.

Christmann V, Gradussen CJ, Körnmann MN, Roeleveld N, van Goudoever JB, van Heijst AF. Changes in biochemical parameters of the calcium-phosphorus homeostasis in relation to nutritional intake in very-low-birth-weight infants. Nutrients. (2016) 29:8 10.3390/nu8120764.

Mimouni FB, Mandel D, Lubetzky R, Senterre T. Calcium, phosphorus, magnesium and vitamin D requirements of the preterm infant. World Rev Nutr Diet. (2014) 110:140–51. 10.1159/000358463.

Yeh JK, Liu CC, Aloia JF. Effects of exercise and immobilization on bone formation and resorption in young rats. Am J Physiol. (1993) 264:E182–9. 10.1152/ajpendo.1993.264.2.E182.

Backström MC, Kouri T, Kuusela AL, Sievänen H, Koivisto AM, Ikonen RS, et al. . Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity. Acta Paediatr. (2000) 89:867e73.

Hung YL, Chen PC, Jeng SF, Hsieh CJ, Peng SS, Yen RF, et al. . Serial measurements of serum alkaline phosphatase for early prediction of osteopaenia in preterm infants. J Paediatr Child Health. (2011) 47:134–9.10.1111/j.1440-1754.2010.01901.x.

Tsakalidis C, Dokos C, Tragiannidis A, Rallis D, Nikolaidis N. Gestational age, body weight and bone metabolism markers in premature infants: a single institution experience of Northern Greece. Acta Paediatr. (2010) 99:99.

Pohlandt F, Mihatsch WA. Reference values for urinary calcium and phosphorus to prevent osteopenia of prematurity. Pediatr Nephrol. (2004) 19:1192–3. 10.1007/s00467-004-1651-5.

Rehman MU, Narchi H. Metabolic bone disease in the preterm infant: current state and future directions. World J Methodol. (2015) 5:115–21. 10.5662/wjm.v5.i3.115.

Moreira A, February M, Geary C. Parathyroid hormone levels in neonates with suspected osteopenia. J Paediatr Child Health. (2013) 49:E12e6. 10.1111/jpc.12052.

Koo WW, Gupta JM, Nayanar VV, Wilkinson M, Posen S. Skeletal changes in preterm infants. Arch Dis Child. (1982) 57:447–52. 10.1136/adc.57.6.447.

Faerk J, Peitersen B, Petersen S, Michaelsen KF. Bone mineralisation in premature infants cannot e predicted from serum alkaline phosphatase or serum phosphate. Arch Dis Child Fetal Neonatal. (2002) 87:F133–6. 10.1136/fn.87.2.F133.

Moghis Ur Rehman and Hassib Narchi. Metabolic bone disease in the preterm infant: Current state and future directions . World J Methodol. 2015 Sep 26; 5(3): 115–121.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Copyright (c) 2020 Array


Download data is not yet available.