Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
Bone. 2021 Feb;143:115648. doi: 10.1016/j.bone.2020.115648. Epub 2020 Sep 17.
Most infants born extremely preterm (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g birthweight) in the post surfactant era (early 1990s) are now surviving into adulthood. Preterm birth/low birthweight are risk factors for reduced bone growth and mineralisation in infants and children. However, little is known about their bone health around peak bone mass and through adult life.
To compare bone health (bone mineral measures, bone structure and strength) in young adults born EP/ELBW with controls (>2499 g birthweight), and within the EP/ELBW group examine perinatal and later variables associated with long term bone health.
A geographic cohort comprising all 297 survivors born EP/ELBW in 1991-92 in the state of Victoria, Australia, and 260 contemporaneous controls (>2499 g birthweight) were recruited into a longitudinal study from birth. At age 25 years, investigations included dual energy X ray absorptiometry and peripheral quantitative computed tomography to measure bone, muscle and soft tissue variables, and fasting blood samples to measure serum 25 hydroxyvitamin D (25(OH)D) and bone turnover markers (BTM). Linear regression analysis, with models fitted using generalised estimating equations, was used to compare outcomes between groups, adjusting for height and weight.
Compared with controls (n = 129), young adults born EP/ELBW (n = 162) had lower areal bone mineral density (g/cm) (mean difference [MD] -0.044; 95% confidence interval [CI] -0.076,-0.013) and Z-scores (MD -0.53; 95% CI -0.75, -0.30) in the femoral neck, and lower total hip Z-score (MD -0.35; 95% CI -0.54, -0.15) after adjusting for height and weight. EP/ELBW males generally displayed more bone and soft tissue deficits than females, compared with their respective controls. Within the EP/ELBW group, early growth, male sex, height and lean mass, muscle measures, 25(OH)D levels, and BTM were independently associated with bone mineral measures, structure or strength.
Young adults born EP/ELBW had evidence of impaired bone health around the age of peak bone mass compared with controls. Further follow-up of the EP/ELBW groups will determine if they have a heightened low-trauma fracture risk in later life.
在表面活性剂时代（20 世纪 90 年代初）之后，大多数极早产儿（EP；<28 周妊娠）或极低出生体重儿（ELBW；<1000 克出生体重）现在都能存活到成年。早产/低出生体重是婴儿和儿童骨骼生长和矿化减少的危险因素。然而，对于他们在达到峰值骨量和成年后的骨骼健康状况，我们知之甚少。
比较极早产儿/极低出生体重儿（EP/ELBW）与对照组（>2499 克出生体重）的年轻人的骨骼健康（骨矿物质测量、骨结构和强度），并在 EP/ELBW 组内检查与长期骨骼健康相关的围产期和后期变量。
一项地理队列研究包括 1991-92 年在澳大利亚维多利亚州出生的所有 297 名 EP/ELBW 幸存者，以及 260 名同期对照组（>2499 克出生体重），从出生起即纳入一项纵向研究。在 25 岁时，进行双能 X 射线吸收法和外周定量计算机断层扫描以测量骨骼、肌肉和软组织变量，并采集空腹血样以测量血清 25 羟基维生素 D（25（OH）D）和骨转换标志物（BTM）。使用广义估计方程拟合模型的线性回归分析用于比较组间结果，调整身高和体重。
与对照组（n=129）相比，极早产儿/极低出生体重儿（n=162）的股骨颈骨矿物质密度（g/cm）（平均差异[MD]-0.044；95%置信区间[CI]-0.076，-0.013）和 Z 评分（MD-0.53；95%CI-0.75，-0.30）较低，经身高和体重调整后，总髋部 Z 评分也较低（MD-0.35；95%CI-0.54，-0.15）。与各自的对照组相比，EP/ELBW 男性的骨骼和软组织缺陷通常比女性更明显。在 EP/ELBW 组内，早期生长、男性、身高和瘦体重、肌肉测量、25（OH）D 水平和 BTM 与骨矿物质测量、结构或强度独立相关。
与对照组相比，极早产儿/极低出生体重儿在达到峰值骨量年龄时骨骼健康状况较差。对 EP/ELBW 组的进一步随访将确定他们在以后的生活中是否有更高的低创伤性骨折风险。
