Gestational Age, Sex and Maternal Parity Correlate with Bone Turnover in Premature Infants

Abstract

Factors affecting bone turnover in premature infants are not entirely clear but certainly are different from those influencing bones of adults and children. To identify fetal and maternal factors that might influence bone turnover, we prospectively studied 50 infants (30 preterm and 20 full-term) born at Ain Shams University Obstetric Hospital in Cairo, Egypt. Maternal parity and medical history and infant's weight, gestational age, gender and anthropometrical measurements were recorded. Cord blood samples were collected and serum type I collagen Cterminal propeptide (PICP) was assessed as a marker for fetal bone formation. First morning urine samples were collected and pyridinoline cross-links of collagen (Pyd) were measured as an index for bone resorption. Serum PICP was higher in premature infants when compared with full-term infants (73.30 Ϯ 15.1 versus 64.3 Ϯ 14.7, p ϭ 0.022) and was higher in male premature infants when compared with females (81.64 Ϯ 9.06 versus 66.0 Ϯ 15.7, p ϭ 0.018). In a multiple regression model using Throughout life, bone is constantly resorbed and new bone is formed. Both modeling and remodeling occur during skeletal growth. Bone modeling results in linear growth and remodeling allows expansion of bone circumference and mineral deposition. Five to twenty percent of the bone mass is actively remodeled by about two million bone remodeling units in the human skeleton at any given time (1,2). The rate of bone turnover in adults differs from children and neonates. In addition, factors affecting such process in adults do not necessarily influence children or neonates (3,4). Premature infants represent a unique vulnerable population, in which bone growth and mineral acquisition are critical. The relation of bone turnover with gestational age and birth weight has been well described (5). However, the impact of other factors such as parity, maternal diseases, and infant's sex on bone turnover in the premature infant are yet to be identified. In this study we used serum concentration of carboxy terminal propeptide of type I procollagen (PICP) in cord blood, as a marker of fetal bone formation (6 -8), and pyridinoline (Pyd) excretion in urine as a biomarker of bone resorption (9,10). PATIENTS AND METHODSPatients. Fifty appropriate-for-gestational-age infants were included in this study. Thirty preterm and twenty term infants were prospectively enrolled. Infants with history of perinatal asphyxia, maternal fever, rupture of amniotic membranes Ͼ18 h, congenital anomalies, liver diseases, and inherited metabolic or genetic disorders were excluded from the study. The study was approved by the institutional review board and parental consents were obtained. Maternal history including maternal age, parity and diabetes mellitus. Length of gestation was estimated using the date of last menstrual period, early antenatal ultrasound when available and the new Ballard scoring system (11). All anthropometrical measurements were done by the same doctor on admission and were plotted against gestational age (1...

Association of Low Birth Weight and Preterm Birth With the Incidence of Knee and Hip Arthroplasty for Osteoarthritis

“…The important role of hip bone shape and geometry in the etiology of hip OA has been established (20). Premature and LBW babies represent a unique vulnerable population, in which bone growth and mineral acquisition are critical in regards to bone turnover (23). A case-control study similarly found reduced peak bone mass at the femoral neck in very LBW babies (3).…”

“…A case-control study similarly found reduced peak bone mass at the femoral neck in very LBW babies (3). There is emerging evidence that preterm birth and very LBW result in a decrease in bone formation and increase in bone resorption (23,24) that reduced osteoclast apoptosis (25) and cartilage degeneration (26), which may be another potential pathway of development of hip OA.…”

Effect of Maternal Age and Birth Order on Foetal Biometric Parameters

“…Thus suggesting that birth order do not affect the development of the foetus. Although Aly et al [22] suggested that Parity and maternal diabetes correlated with type 1 procollagen C-terminal propeptide (PICP) which is a bone formation marker; as increase in maternal parity correlated negatively with PICP concentration, but their study did not show a correlation with the developed bony structures. Studies have shown that increase in maternal age increases the chances of Trisomy; diagnosed by foetal nasal bone morphology (nuchal translucency; NT) while decrease in maternal vitamin D level which may be associated with increasing age could affect foetal bone characteristics.…”

53: Is Caffeine a Risk Factor for Osteopenia of Prematurity?

“…At term, this difference was no longer observable. The gender-difference in serum procollagen type-I carboxy-terminal propeptide may reflect differences in the production of the collagen degradation markers by skeletal and non-skeletal cells in premature infants (Aly, Moustafa, Amer, Hassanein, Keeves, & Patel, 2005). But this difference in BMC was not observed in another study by Namgun, & Tsang, 2000 who stated that gender differences in BMC appear in early life between 1-18 month of age but probably not at birth (Namgung, & Tsang, 2000).…”