Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity

Backström, MC; Kouri, Timo; Kuusela, Anna‐Leena; Sievänen, Harri; Am, Koivisto; Ikonen, Riikka; Mäki, Markku

doi:10.1111/j.1651-2227.2000.tb00395.x

Cited by 142 publications

(64 citation statements)

References 30 publications

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“…39 Although urinary excretion of calcium and phosphate were not related to QUS in our study, AP correlated inversely with QUS, which confirms reports applying both QUS and DXA that found AP to predict reduced bone density with a sensitivity of 88% and a specificity of 71%. 14,15,40,41 The lack of correlation between AP or QUS and serum levels of calcium or phosphate in our patients is most likely due to the stringent regulation of these two minerals by a complex endocrine system to keep their serum levelFessential for many organ functionsFwithin normal limits. As expected, several risk factors for reduced bone formation showed a relevant influence on QUS, that is, the duration of parenteral nutrition or mechanical ventilation and the treatment with diuretics or corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound for the assessment of bone quality in preterm and term infants

Rack

Janni

et al. 2011

J Perinatol

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Objective: As 80% of intrauterine bone mineralization takes place during the last trimester of pregnancy, preterm infants should be supplemented postnatally with optimal doses of calcium, phosphate and vitamin D. Calcium and phosphate excretion in the urine may be used to monitor individual mineral requirements, but are sometimes difficult to interpret. The objective of this study was to assess the value of quantitative ultrasound (QUS) for the analysis of bone status in neonates.Study Design: All admissions to three independent tertiary neonatal intensive care units were studied. In 172 preterm and term infants with a gestational age between 23 and 42 weeks (mean 33.8 ± 5.0) and a birth weight from 405 to 5130 g (mean 2132±1091 g) bone status was evaluated prospectively by quantitative ultrasound velocity using a standardized protocol. Infants were followed in regular intervals up to their first discharge home. While measurements were conducted in weekly intervals initially (n ¼ 55), 2-week intervals were regarded as sufficient thereafter due to limited changes in QUS values within the shorter period. Infants with a birth weight below 1500 g were followed during outpatient visits until up to 17 months of age.Result: The intra-individual day-to-day reproducibility was 0.62%. QUSvalues from the first week of life correlated significantly with gestational age and birth weight (r ¼ 0.5 and r ¼ 0.6; P<0.001). Small-forgestational-age infants showed lower values for QUS than appropriate-forgestational-age infants allowing for their gestational age. Follow-up measurements correlated positively with age and weight during the week of measurement (r ¼ 0.2 and r ¼ 0.4; P ¼ 0.001). Comparing bone quality at 40 weeks of age in infants born at term versus infants born at 24 to 28 weeks, preterm infants showed significantly lower QUS than term infants (P<.0001).There was a significant correlation of QUS with serum alkaline phosphatase (P ¼ 0.003), the supplementation with calcium, phosphate and vitamin D (P< 0.001 each), as well as risk factors for a reduced bone mineralization. No correlation was found between QUS and calcium or phosphate concentration in serum or urine.Conclusion: QUS is a highly reproducible, easily applicable and radiation-free technique that can be used to monitor bone quality in individual newborns. Further prospective randomized-trials are necessary to evaluate, if therapeutic interventions based on QUS are able to prevent osteopenia of prematurity.

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Section: Discussionmentioning

confidence: 99%

Ultrasound for the assessment of bone quality in preterm and term infants

Rack

Janni

et al. 2011

J Perinatol

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“…At present, there are no data demonstrating clinical utility of measuring serum osteocalcin concentration and bone-specific APA in neonates, and normal values do not exist for preterm infants. Backstrom et al 19 found no additional information gained from measurement of bone-specific APA compared with total APA in preterm infants. It is, therefore, unlikely that these laboratory values, which are poorly standardized in neonates and expensive to obtain, will be a substantial aspect of clinical decisionmaking in an individual infant.…”

Section: In-hospital Assessment and Managementmentioning

confidence: 99%

Calcium and Vitamin D Requirements of Enterally Fed Preterm Infants

Abrams¹

2013

Pediatrics

287

257

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Bone health is a critical concern in managing preterm infants. Key nutrients of importance are calcium, vitamin D, and phosphorus. Although human milk is critical for the health of preterm infants, it is low in these nutrients relative to the needs of the infants during growth. Strategies should be in place to fortify human milk for preterm infants with birth weight <1800 to 2000 g and to ensure adequate mineral intake during hospitalization and after hospital discharge. Biochemical monitoring of very low birth weight infants should be performed during their hospitalization. Vitamin D should be provided at 200 to 400 IU/day both during hospitalization and after discharge from the hospital. Infants with radiologic evidence of rickets should have efforts made to maximize calcium and phosphorus intake by using available commercial products and, if needed, direct supplementation with these minerals.

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“…Backstrom et al (25) reported that a serum ALP value above 900 U/L was related with low bone mineral density, its sensitivity was 88% and specificity was 71% and a serum P level of <5,5 mg/dL was related with low bone mineral density and its sensitivity was 96% and specificity was 50%. Glass et al (26) reported that an ALP value of >900 IU/l had a sensitivity of 100% in the diagnosis of osteopenia and combination of an ALP value of >800 IU/dL and a P value of <3.5 mg/dL defined severe osteopenia.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the place of tubular reabsorption of phosphorus in the diagnosis of osteopenia of prematurity

et al. 2015

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Aim: In this study, we aimed to investigate the utility of tubular reabsorption of phosphorus in the diagnosis of osteopenia of prematurity in addition to biochemical markers. Material and Methods: Premature babies with a gestational age of ≤32 weeks and/or a birth weight of ≤1 500 g who were hospitalized in the neonatal intensive care unit between June 2009 and March 2011 were included in the study. These babies were evaluated at the 40th gestational week and serum calcium, phosphorus, alkaline phosphatase, urea, creatinine, urinary calcium and phosphorus levels were measured and tubular reabsorption of phosphorus was determined. The subjects who had bone graphy findings and/or an alkaline phosphatase level of >400IU/L and a phosphorus value of <3.5 mg/dL were considered osteopenic. The levels of tubular reabsorption of phosphorus of the osteopenic patients were compared with the ones of the non-osteopenic patients. The study was initiated after obtaining ethics committee approval (date: 04.29.2009/213). Results: During the study period, a total of 698 premature babies were hospitalized in our neonatology unit. A diagnosis of osteopenia of prematurity was made in 24 of 190 subjects who met the study criteria. The level of tubular reabsorption of phosphorus was compared with the serum calcium, phosphorus and alkaline phosphatase levels measured at the 40th gestational week and alkaline phosphatase was found to be significantly increased in the group with a high tubular reabsorption of phosphorus (≥%95). When the subjects with a phosphorus level of <3.5 mg/dL and an alkaline phosphatase level of >499 IU were compared with the newborns who were found to have a tubular reabsorption of phosphorus of ≥%95 for the objective of evaluating the specificity and sensitivity of tubular reabsorption of phosphorus, the sensitivity, specificity, positive predictive value and negative predictive value of tubular reabsorption of phosphorus in the diagnosis of osteopenia were found to be 27%, 82%, 17% and 89%, respectively. When the osteopenic and non-osteopenic patients were compared in terms of the levels of tubular reabsorption of phosphorus, no statistically significant difference was found. Conclusions: It was thought that it was not appropriate to use tubular reabsorption of phosphorus alone in the diagnosis of osteopenia of prematurity. (Türk Ped Arş 2015; 50: 45-50)

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Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity

Cited by 142 publications

References 30 publications

Ultrasound for the assessment of bone quality in preterm and term infants

Ultrasound for the assessment of bone quality in preterm and term infants

Calcium and Vitamin D Requirements of Enterally Fed Preterm Infants

Assessment of the place of tubular reabsorption of phosphorus in the diagnosis of osteopenia of prematurity

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