Grover Monica, Ashraf Ambika P, Bowden Sasigarn A, Calabria Andrew, Diaz-Thomas Alicia, Krishnan Sowmya, Miller Jennifer L, Robinson Marie-Eve, DiMeglio Linda A
Division of Pediatric Endocrinology, Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA.
Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Horm Res Paediatr. 2025;98(1):40-50. doi: 10.1159/000536228. Epub 2024 Jan 11.
Metabolic bone disease of prematurity (MBDP) is defined by undermineralization of the preterm infant skeleton arising from inadequate prenatal and postnatal calcium (Ca) and phosphate (PO4) accretion. Severe MBDP can be associated with rickets and fractures. Despite advances in neonatal nutrition, MBDP remains prevalent in premature infants due to inadequate mineral accretion ex utero. There also remain significant knowledge gaps regarding best practices for monitoring and treatment of MBDP among neonatologists and pediatric endocrinologists. Preventing and treating MBDP can prevent serious consequences including rickets or pathologic fractures. Postnatal monitoring to facilitate early recognition of MBDP is best done by first-tier laboratory screening by measuring serum Ca, phosphorus, and alkaline phosphatase to identify infants at risk. If these laboratories are abnormal, further studies including assessing parathyroid hormone and/or tubular resorption of PO4 can help differentiate between Ca and PO4 deficiency as primary etiologies to guide appropriate treatment with mineral supplements. Additional research into optimal mineral supplementation for the prevention and treatment of MBDP is needed to improve long-term bone health outcomes and provide a fuller evidence base for future treatment guidelines. Metabolic bone disease of prematurity (MBDP) is defined by undermineralization of the preterm infant skeleton arising from inadequate prenatal and postnatal calcium (Ca) and phosphate (PO4) accretion. Severe MBDP can be associated with rickets and fractures. Despite advances in neonatal nutrition, MBDP remains prevalent in premature infants due to inadequate mineral accretion ex utero. There also remain significant knowledge gaps regarding best practices for monitoring and treatment of MBDP among neonatologists and pediatric endocrinologists. Preventing and treating MBDP can prevent serious consequences including rickets or pathologic fractures. Postnatal monitoring to facilitate early recognition of MBDP is best done by first-tier laboratory screening by measuring serum Ca, phosphorus, and alkaline phosphatase to identify infants at risk. If these laboratories are abnormal, further studies including assessing parathyroid hormone and/or tubular resorption of PO4 can help differentiate between Ca and PO4 deficiency as primary etiologies to guide appropriate treatment with mineral supplements. Additional research into optimal mineral supplementation for the prevention and treatment of MBDP is needed to improve long-term bone health outcomes and provide a fuller evidence base for future treatment guidelines.
早产代谢性骨病（MBDP）的定义是，由于产前和产后钙（Ca）及磷（PO4）蓄积不足，导致早产婴儿骨骼矿化不足。严重的MBDP可能与佝偻病和骨折有关。尽管新生儿营养有所进步，但由于宫外矿物质蓄积不足，MBDP在早产儿中仍然很普遍。在新生儿科医生和儿科内分泌专家中，关于MBDP监测和治疗的最佳实践也仍存在重大知识空白。预防和治疗MBDP可以预防包括佝偻病或病理性骨折在内的严重后果。为便于早期识别MBDP，产后监测最好通过一级实验室筛查进行，即测量血清钙、磷和碱性磷酸酶，以识别有风险的婴儿。如果这些实验室指标异常，进一步的检查，包括评估甲状旁腺激素和/或磷的肾小管重吸收，有助于区分钙缺乏和磷缺乏作为主要病因，以指导用矿物质补充剂进行适当治疗。需要对预防和治疗MBDP的最佳矿物质补充进行更多研究，以改善长期骨骼健康结果，并为未来的治疗指南提供更充分的证据基础。早产代谢性骨病（MBDP）的定义是，由于产前和产后钙（Ca）及磷（PO4）蓄积不足，导致早产婴儿骨骼矿化不足。严重的MBDP可能与佝偻病和骨折有关。尽管新生儿营养有所进步，但由于宫外矿物质蓄积不足，MBDP在早产儿中仍然很普遍。在新生儿科医生和儿科内分泌专家中，关于MBDP监测和治疗的最佳实践也仍存在重大知识空白。预防和治疗MBDP可以预防包括佝偻病或病理性骨折在内的严重后果。为便于早期识别MBDP，产后监测最好通过一级实验室筛查进行，即测量血清钙、磷和碱性磷酸酶，以识别有风险的婴儿。如果这些实验室指标异常，进一步的检查，包括评估甲状旁腺激素和/或磷的肾小管重吸收，有助于区分钙缺乏和磷缺乏作为主要病因，以指导用矿物质补充剂进行适当治疗。需要对预防和治疗MBDP的最佳矿物质补充进行更多研究，以改善长期骨骼健康结果，并为未来的治疗指南提供更充分的证据基础。
