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Parathyroid hormone as a marker for metabolic bone disease of prematurity
A Moreira1, L Swischuk2, M Malloy2
1Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX, USA.
Insights
Parathyroid hormone (PTH) is a more sensitive early marker than alkaline phosphatase (ALP) for detecting metabolic bone disease (MBD) in preterm infants. This finding aids in early diagnosis and management of bone health in vulnerable neonates.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Biochemistry
Background:
- Metabolic bone disease (MBD) is a significant concern in preterm infants.
- Current serologic markers for MBD have limitations in sensitivity and early detection.
Purpose of the Study:
- To compare the efficacy of parathyroid hormone (PTH) and alkaline phosphatase (ALP) as serologic markers for MBD in preterm neonates.
- To identify the most sensitive and specific marker for early MBD screening.
Main Methods:
- Prospective observational study involving neonates with birth weight < 1250 g.
- Simultaneous measurement of serum PTH, ALP, calcium, and phosphorus at scheduled intervals.
- MBD evaluation using knee radiographs at 6 weeks of age; statistical analysis using ROC curves.
Main Results:
- Parathyroid hormone (PTH) demonstrated higher sensitivity (71%) compared to alkaline phosphatase (ALP) (29%) for severe MBD at specific cutoffs.
- ALP showed high specificity (93%), while PTH also had good specificity (88%).
- Infants with severe MBD had lower birth weight, lower 21-day serum phosphorus, and increased glucocorticoid/caffeine use.
Conclusions:
- PTH is a superior early serologic marker for MBD in preterm infants due to its higher sensitivity.
- Combined PTH and phosphorus levels at 3 weeks can achieve 100% sensitivity and 94% specificity for severe MBD.
Objective:
To compare parathyroid hormone to alkaline phosphatase as a serologic marker for metabolic bone disease (MBD) in preterm infants.
Study Design:
An 18-month prospective observational study in neonates with birth weight < 1250 g. Simultaneous serum parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium (Ca) and phosphorus (P) were measured at scheduled intervals during hospitalization. At 6 weeks of age, MBD was evaluated using knee radiographs. Comparisons were analyzed using multivariate logistic regression, receiver operating characteristic (ROC) curves, χ² and Student t-test.
Result:
Fourty-nine infants were included in the study: 7 with severe and 42 with mild MBD. Using ROC curves, at 660 U l⁻¹ ALP had a sensitivity of 29% and specificity of 93% for severe MBD, while a cutoff point of 180 pg ml⁻¹ gave PTH a sensitivity of 71% and specificity of 88%. Infants with severe bone disease had a lower birth weight, 21-day serum P, an increased use of glucocorticoids and caffeine, and more likely to have major neonatal morbidities.
Conclusion:
PTH is an early marker with better sensitivity than ALP in screening for MBD. At 3 weeks chronologic age, a PTH level > 180 mg dl⁻¹ or a P level <4.6 pg ml⁻¹ yielded a sensitivity of 100% and specificity of 94% for severe MBD [corrected].
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