Metabolic Bone Disease and Bone Mineral Density in Very Preterm Infants

ObjectivesTo evaluate bone mineral density (BMD) in preterm neonates at discharge and identify the optimum cutoff values for serum alkaline phosphatase (ALP) and phosphorus (P) concentrations to diagnose the severity of metabolic bone disease of prematurity.Study designA total of 336 preterm neonates (≤31 weeks' gestation and birth weight ≤1500 g) were prospectively evaluated for BMD before discharge using dual-energy X-ray absorptiometry.ResultsBMD reference values (at ALP ≤500 IU/L) were measured in 279 patients. BMD was classified as poor (<10th percentile) at <0.068 g/cm2, fair (10th-25th percentile) at 0.068-0.081 g/cm2, good (25th-75th percentile) at 0.081-0.112 g/cm2, and very good (>75th percentile) at >0.112 g/cm2. Increased BMD was associated with a higher birth weight, short duration of parenteral nutrition, and the absence of small for gestational age status, patent ductus arteriosus, intraventricular hemorrhage, and other clinical variables. Metabolic bone disease of prematurity was absent (ALP ≤500 IU/L) in 279 cases (83.0%), mild (ALP >500 IU/L and P ≥4.5 mg/dL) in 46 cases (13.7%), and severe (ALP >500 IU/L and P <4.5 mg/dL) in 11 cases (3.3%).ConclusionsA BMD >0.068 g/cm2 at discharge indicated a 90.3% probability of not developing metabolic bone disease of prematurity. The factors independently associated with increased BMD included higher birth weight, short duration of parenteral nutrition, absence of intraventricular hemorrhage, exclusive feeding of fortified breast milk, and older age at discharge.