Background and Aims
Very low birth weight (VLBW) infants are at risk of osteopenia of prematurity (OOP) and related skeletal fractures. Improved nutritional management in recent years should reduce the incidence of OOP. However, increased use of medications, such as postnatal steroids, may have a negative effect on bone health.

It can be difficult to detect early signs of OOP and often the process is quite advanced by the time X-ray changes are evident. 

Our aim was to examine which biochemical markers best predicted radiologically significant OOP and thus better target our treatment and follow up.

Methods
Retrospective review of all X-rays carried out on VLBW infants over a 5-year period in a tertiary neonatal centre. We compared the biochemical markers of OOP in those with and without radiological signs of OOP. We defined OOP radiologically as infants with Stage 1 and above X-ray changes as per Koo et. al.

Results
Of the 609 VLBW infants included in the study, 5.9% of these babies showed radiological evidence of OOP.  

Average gestation of babies born with OOP was 26+3 weeks and it took, on average, 6.5 weeks for radiological evidence of OOP to be seen. 

As shown in table 2, highest alkaline phosphatase, duration of raised alkaline phosphatase and duration of low phosphate best predicted OOP.

Conclusion
The time duration with elevated alkaline phosphatase and low phosphate were strong predictors of OOP. Using this information it can be concluded that promptly correcting high alkaline phosphatase and low phosphate should have an impact on reducing OOP in these babies.

OSTEOPENIA OF PREMATURITY, CAN WE PREDICT IT? CAN WE STOP IT?