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.
Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences
A. Chinoy,M. Z. Mughal,R. Padidela
Published 2019 in Archives of Disease in Childhood: Fetal and Neonatal Edition
ABSTRACT
PUBLICATION RECORD
- Publication year
2019
- Venue
Archives of Disease in Childhood: Fetal and Neonatal Edition
- Publication date
2019-05-11
- Fields of study
Medicine
- Identifiers
- External record
- Source metadata
Semantic Scholar, PubMed
CITATION MAP
EXTRACTION MAP
CLAIMS
CONCEPTS
- biochemical investigations
Laboratory-based measurements used in the evaluation of metabolic bone disease of prematurity.
- calcipaenia
A low-calcium state considered one possible aetiology of metabolic bone disease of prematurity in the abstract.
- diagnostic or screening test
A test intended to detect or confirm metabolic bone disease of prematurity.
- metabolic bone disease of prematurity
A skeletal demineralisation disorder seen in preterm infants and discussed as the central condition in the abstract.
Aliases: MBDP
- phosphate supplements alone
A supplementation approach in which phosphate is given without accompanying calcium in the context of preterm bone disease management.
- phosphopaenia
A low-phosphate state considered one possible aetiology of metabolic bone disease of prematurity in the abstract.
- plasma parathyroid hormone
The circulating parathyroid hormone measurement used here to help infer the underlying mineral deficit in metabolic bone disease of prematurity.
- radiological investigations
Imaging-based assessments used in the evaluation of metabolic bone disease of prematurity.
- secondary hyperparathyroidism
A compensatory parathyroid hormone excess state associated with altered mineral supplementation in preterm infants.
REFERENCES
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