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The Clinical and Biochemical Predictors of Bone Mass in Preterm Infants
Justyna Czech-Kowalska1, Edyta Czekuc-Kryskiewicz2, Pawel Pludowski2
1Department of Neonatology and Neonatal Intensive Care, The Children's Memorial Health Institute, Warsaw, Poland.
Insights
Serum iPTH predicts reduced bone mineral content (BMC) in preterm infants at term. Later, urinary phosphate and osteocalcin levels predict lower BMC by 3 months corrected age, offering simple diagnostic tools.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Biochemistry
Background:
- Metabolic bone disease remains a concern in preterm infants despite advances in neonatal care.
- Dual-energy X-ray absorptiometry (DXA) accurately measures bone mineral content (BMC) but lacks widespread availability.
Purpose of the Study:
- To identify clinical and biochemical predictors of BMC in preterm infants up to 3 months corrected age (CA).
- To explore bone metabolism markers for predicting BMC in this vulnerable population.
Main Methods:
- Prospective study of 184 preterm infants (≤ 34 weeks' gestation) from term age to 3 months CA.
- Assessed calcium-phosphate homeostasis, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D, osteocalcin, and other markers, alongside DXA scans.
Main Results:
- Higher iPTH levels independently predicted lower BMC at term.
- Lower BMC at 3 months CA correlated with reduced urinary phosphate excretion and elevated serum osteocalcin.
- Receiver operating characteristic (ROC) analysis demonstrated predictive values for iPTH, urinary phosphate, and osteocalcin.
Conclusions:
- Serum iPTH may predict reduced BMC at term in preterm infants.
- Urinary phosphate excretion and serum osteocalcin show potential for predicting reduced BMC at 3 months CA.
- These findings suggest simple biochemical markers can aid in assessing bone mass in preterm infants.
Background:
Metabolic bone disease of prematurity still occurs in preterm infants, although a significant improvement in neonatal care has been observed in recent decades. Dual-energy X-ray absorptiometry (DXA) is the precise technique for assessing bone mineral content (BMC) in preterm infants, but is not widely available.
Aim:
To investigate the clinical and biochemical parameters, including bone metabolism markers as potential predictors of BMC, in preterm infants up to 3 months corrected age (CA).
Materials And Methods:
Ca-P homeostasis, iPTH, 25-hydroxyvitamin D, osteocalcin, N-terminal propeptide, cross-linked C-telopeptide and amino-terminal pro C-type natriuretic peptide and the DXA scans were prospectively performed in 184 preterm infants (≤ 34 weeks' gestation) between term age and 3 mo CA. Lower bone mass was defined as BMC below or equal to respective median value for the whole study group, rounded to the nearest whole number.
Results:
The appropriate quality DXA scans were available for 160 infants (87%) examined at term and for 130 (71%) tested at 3 mo CA. Higher iPTH level was the only independent predictor of lower BMC at term, whereas lower BMC at 3 mo CA was associated both with lower urinary phosphate excretion and higher serum osteocalcin level. ROC analysis showed that iPTH >43.6 pg/mL provided 40% sensitivity and 88% specificity in identification of preterm infants with lower BMC at term. In turn, urinary phosphate excretion (TRP>97% or UP/Cr ≤0.74 mg/mg) and serum osteocalcin >172 ng/mL provided 40% sensitivity and 93% specificity in identification of infants with decreased BMC at 3 mo CA.
Conclusion:
Serum iPTH might to be a simple predictor of reduced BMC in preterm infants at term age, but urinary phosphate excretion and serum osteocalcin might predict reduced BMC at 3 mo CA. These results represent a promising diagnostic tool based on simple, widely available biochemical measurements for bone mass assessment in preterm infants.
