title: Metabolic bone disease and bone mineral density in very preterm infants.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  BMD reference values (at ALP ≤ 500 IU/L) were measured in 279 patients. BMD was classified as poor (<10th percentile) at <0.068 g/cm(2), fair (10th-25th percentile) at 0.068-0.081 g/cm(2), good (25th-75th percentile) at 0.081-0.112 g/cm(2), and very good (>75th percentile) at >0.112 g/cm(2). 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%).
  
  
  CONCLUSIONS
  A BMD >0.068 g/cm(2) 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.
authors: Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain. Electronic address: jfiguer@clinic.ub.es.
authors: Josep
authors: J
authors: Figueras-Aloy
authors: Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Enriqueta
authors: E
authors: Álvarez-Domínguez
authors: Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: José M
authors: JM
authors: Pérez-Fernández
authors: Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Gloria
authors: G
authors: Moretones-Suñol
authors: Nuclear Medicine Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Sergi
authors: S
authors: Vidal-Sicart
authors: Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Francesc
authors: F
authors: Botet-Mussons
mesh_terms: D000367:Age Factors; D000469:Alkaline Phosphatase / Q000097:blood; D001724:Birth Weight; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000175:diagnosis*; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000175:diagnosis; D008297:Male; D008895:Milk, Human / Q000737:chemistry; D015999:Multivariate Analysis; D010288:Parenteral Nutrition; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D010758:Phosphorus; D000469:Alkaline Phosphatase