A European perspective on metabolic bone disease of prematurity

Introduction Preterm infants have an increased risk of poor bone health and therefore of metabolic bone disease (MBD) of prematurity with typical complications such as fractures after the 3rd week of life. Screening for MBD is often started at the 2nd or 3rd week of life. However, there is no consensus on diagnosis or management of MBD in high-risk preterm infants.

Aim The aim of this study was to evaluate clinical relevance, diagnostic procedures and treatment strategies for MBD across Europe.

Methods An electronic survey was distributed to 545 different neonatal units within 38 European countries between July 2021 to October 2021. The CHERRIES (Checklist for Reporting Results of Internet E-Surveys) protocol was used as a methodological guideline. As respondents were allowed to skip questions, the population varied between responses.

Results Responses were retrieved from 76 neonatal units from 22 different European countries (response rate 14%). Forty-seven (63%) responding units treated 50 and more very low birth weight (VLBW) infants annually. Twenty-eight units (37%) treated less than 50 VLBW infants per year.

In the past 12 months, 22 (29%) units reported at least one symptomatic case of fracture associated with MBD and craniofacial deformities occurred in 15 (20%) units. All participants (100%) considered gestational age and/or birth weight as risk factor for MBD. Total parental nutrition for more than 14 days was considered a risk factor for MBD in forty-eight (66%) units. Fifty-six (77%) units reported the use of a local guideline for diagnosis and/or management of MBD. Diagnosis of MBD was based on blood tests (serum parameters), urinary markers, diagnostic imaging and clinical symptoms according to these local guidelines. Some units used a combination of these parameters. The most used blood tests were alkaline phosphatase (ALP) and serum phosphate, either for diagnosis in 66 (92%) units or as an indication for treatment in 65 (90%) units [1] [2] [3] [4] [5].

In 37 (51%) units urinary calcium was used as urinary marker, urinary phosphate in 32 (44%) units, and urinary Ca/Crea and P/Crea ratios in 22 (31%) units. The combination of urinary phosphate and urinary calcium was only used in Germany, Switzerland and Bulgaria. MBD was treated with supplementation of phosphate in 59 (83%) units, calcium in 57 (80%) units and vitamin D in 55 (76%) units. Breast milk was fortified regularly in 74 (99%) units.

Conclusion Twenty-nine percent of units reported fractures associated with MBD of prematurity. Diagnostic procedures and treatment strategies are highly variable across European neonatal units. To reduce the number of symptomatic cases of fractures and craniofacial deformities, an evidence-based consensus guideline is urgently needed.

Interessenkonflikt

Die Autor*innen erklären, dass keine potenziellen Interessenkonflikte, weder reale noch wahrgenommene, bestehen.

• Literatur

• 1 Matheisl D., Kidszun A.. Die Frühgeborenenosteopenie – Pathophysiologie und Diagnostik. Neonatol. Scan 2022; 11: 147-160
• 2 Rustico S.E., Calabria A.C., Garber S.J.. Metabolic bone disease of prematurity. J. Clin. Transl. Endocrinol 2014; 1: 85-91
• 3 Faienza M.F.. et al. Metabolic Bone Disease of Prematurity: Diagnosis and Management. Front. Pediatr. 2019; 7: 143
• 4 Lee B., De Beritto T.. Metabolic Bone Disease of Prematurity. NeoReviews 2022; 23: e311-e318
• 5 Eysenbach G.. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J. Med. Internet Res. 2004; 6: e34-e34

Publication History

Article published online:
06 June 2023