Abstract
Metabolic bone disease of prematurity is characterised by disordered bone mineralisation and is therefore an increased fracture risk. Preterm infants are especially at risk due to incomplete in utero bone accretion during the last trimester. Currently, diagnosing metabolic bone disease mainly relies on biochemistry and radiographs. Dual-energy x-ray absorptiometry and quantitative ultrasound (US) are used less frequently. However, biochemical measurements correlate poorly with bone mineralisation and although scoring systems exist for metabolic bone disease, radiographs are subjective and do not detect early features of osteopenia. Dual energy x-ray absorptiometry is the reference standard for determining bone density in older children and adults. However, challenges with this method include movement artefact, difficulty scanning small and sick infants and a lack of normative data for young children. Quantitative US has a relatively low cost, is radiation-free and portable, and may hence be suitable for assessing bone status in preterm infants. This review aims to provide an overview of the use of quantitative US in detecting metabolic bone disease in preterm infants.
Highlights
Metabolic bone disease and osteogenesis imperfecta are the two most common causes of fragile bones in infancy [1]
Metabolic bone disease is characterised by skeletal demineralisation and fractures that can occur during normal handling [2]
We evaluate studies that have used a total of four commercially available quantitative US devices: Omnisense 7000P (Sunlight Medical Inc., Tel Aviv, Israel), DBM Sonic (IGEA, Capri, Italy), DBM Bone Profiler (IGEA, Capri, Italy) and Osteoson KIV (Minhorst, Medut, Germany)
Summary
Metabolic bone disease and osteogenesis imperfecta are the two most common causes of fragile bones in infancy [1]. In Ashmeade et al [7], there was a significant positive correlation between speed of sound measurements and birth weight among preterm infants. Significant positive correlation in birth weight and SOS measurements in preterm infants, but negative correlation in term infants This might suggest that lower rates of interuterine growth are associated with high SOS values. AGA appropriate for gestational age, BTT bone transmission time, LGA large for gestational age, SGA small for gestational age, SOS speed of sound. The study found that metacarpal bone transmission time was correlated to serum phosphate, phosphaturia and calciuria in the third week of life and suggested that these three biochemical tests could be used in the workup of metabolic bone disease This observation was made in Ashmeade et al [7] and Rack et al [23]. They found that there was a significant increase in bone specific alkaline phosphatase and significant decrease in carboxy terminal cross-links telopeptide of Type-1 collagen, both parameters remained within the normal range and there were no significant correlations between bone turnover markers and speed of sound
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