Evidence Of Metabolic Bone Disease Research Articles

Adipositas and metabolic bone disorder in a 16th century Upper Austrian infant crypt mummy-An interdisciplinary palaeopathological insight into historical aristocratic life.

We describe here the results of a multidisciplinary study on an infant mummy from 16th century Upper Austria buried in the crypt of the family of the Counts of Starhemberg. The macroscopic-anthropological, radiological (whole-body CT scan), histological (skin tissue), and radiocarbon isotope investigations suggested a male infant of 10-18 months' age, most likely dying between 1550 and 1635 CE (probably Reichard Wilhelm, 1625-1626 CE), that presented with evidence of metabolic bone disease with significant bilateral flaring of costochondral joints resembling "rachitic rosary" of the ribs, along with straight long bones and lack of fractures or subperiosteal bleeding residues. Although incompletely developed, the osteopathology points toward rickets, without upper or lower extremities long bone deformation. The differential diagnosis is vitamin C deficiency (scurvy) (also with an incomplete presentation, although overlap between both disorders may be present). As additional pathology, there was significantly enlarged subcutaneous fat tissue (thickness more than 1 cm at the navel and thighs and longitudinal creases of the skin) along with a histologically enlarged subcutaneous fat layer consistent with infantile adipositas as a coincident disorder. Finally, remnants of lung tissue with pleural adhesion of the right lung indicate possibly lethal pneumonia, a disease with an increased prevalence in vitamin D deficient infants. Ultimately, the skull presented with extensive destruction of the bones of the base and dislocation of the bones of the skull squama. These changes, however, are most likely post-mortal pseudopathology, the result of a burial in a flat, narrow coffin because there were no bone fractures or residues of bleeding/tissue reaction that would have occurred whilst the patient was alive.

Ancient Egyptian paleopathology – The population of the tomb of IPI, necropolis of Dahshur-South

This study investigated the human remains of the tomb complex built by the ancient Egyptian high ranking official “Ipi” (4th Dynasty, ca. 2700-2600 BCE) in the Lower Egyptian necropolis of Dahshur-South. Beyond burials from the tomb owner and his family from the Old Kingdom, the complex was re-used until the Late Period. The excavated material presented the human remains of at least 73 individuals. Unfortunately, initial excavations had collected and mixed individual burials, so that individual identification in most skeletons was not possible. Later excavations presented complete individual burials. The custom typical of the New Kingdom until the Late Period of transnasal trephination offered, even with the mixed burials, a collection of 23 disturbed adults’ skulls (New Kingdom until Late Period) and 33 skulls of undisturbed adults (Old Kingdom). In these two groups sex ratios were fairly balanced. Most adult individuals died between 20 to 30 years. There were relatively few immature burials and a single skeleton was that of a 7th lunar month fetus, an obvious stillbirth; total number of immature was 10 (17.8%). Numerous paleopathological observations indicated the considerable impact of living conditions and health. There were 12 cases with healed traumatic sequelae including one with a healed ankylosed fracture of the knee and another with a fracture of the humerus, three cases of nonspecific osteomyelitis, three cases highly suggestive of spinal tuberculosis, one with evidence of metabolic bone disease from vitamin deficiency, and two cases with malignant bone tumours; one with multiple metastases of the vertebrae, and the other chondrosarcoma of the pelvis. Also, typical pathological changes were seen in teeth and jaws. Finally, the rate of osteoarthrosis of large joints and that of spondylosis suggest significant work load. These findings indicate various ailments either due to heavy work load (arthrosis and spondylosis, traumatic sequelae), or to the living conditions (tooth abrasion by sand ingestion; tuberculosis due to foundation of settlements and townships), metabolic osteopathies possibly due to parasitic diseases and/ or malnutrition. These skeletal remains therefore contribute to our understanding of ancient Egyptian life and diseases.

Metabolic Bone Disease of Prematurity.

Metabolic Bone Disease of Prematurity.

Evaluation of radiologic evidence of metabolic bone disease in very low birth weight infants at fourth week of life.

AimThe aim of this study is to determine the incidence of metabolic bone disease (MBD) and assess the risk factors for development radiologic evidence of MBD.MethodsPreterm infants with gestational age ≤32 weeks and birth weight ≤1500 g were included in this prospective study. Metabolic bone disease was defined as hypophosphatemia (phosphorus levels <4 mg/dl), ALP levels >450 U/L, or radiologic findings of MBD at four weeks of age.ResultsThe study included 254 infants (gestational age: 29 (27–30) weeks, birth weight: 1130 g (960–1300)). Metabolic bone disease was diagnosed in 96 patients (37%); 48 infants had only radiologic evidence of MBD, 24 infants had only biochemical diagnosis of MBD, and 24 infants had both radiologic evidence of MBD and biochemical diagnosis of MBD.ConclusionsOur results showed that radiologic evidence of MBD existed in some infants with normal biochemical results. That finding may guide further development of screening programs for MBD.

Effects of calcium and phosphorus supplementation on metabolic bone disorders in premature infants

Introduction: Every year, 15 million babies are born prematurely around the world of which more than 1 million die as a result of prematurity. Premature infants are considered to be at high risk for developing osteopenia due to their reduced bone mineral content. Mothers milk containing 25-35 mg/dl of calcium and 10-15 mg/dl of phosphorus simply does not contain enough minerals to support skeletal growth of growing premature infants. Supplement of calcium and phosphorus along with breast milk can reduce the rate of osteopenia and improve the growth of premature infants. Objective of the study: To determine the efficacy of calcium and phosphorus supplementation for prevention of metabolic bone disease and improvement of growth in preterm infants. Methodology: A randomized clinical trial study was conducted at Department of Neonatology, BSMMU, from 16th August 2016 to 27th August 2017. It involved monitoring 50 premature neonates over a period of six weeks. The babies who were fed with breast milk were randomly divided into two equal groups. One group received supplement of calcium and phosphorus along with breast milk. Serum calcium, phosphorus and alkaline phosphatase levels as well as growth parameters (including weight, length, and head circumference) were measured at enrollment and at 6 weeks post birth. At the end of 6 weeks, wrist X-ray was done for evaluation of osteopenia. Data was analyzed using SPSS 20. Results: Radiological and biochemical evidence of metabolic bone disease were found in 6 (28%) supplemented group and 7 (35%) non-supplemented group (p=0.45). S. calcium, S. inorganic phosphate and S. alkaline phosphatase level were comparable at enrollment between two groups. At 6 weeks S. calcium, S. inorganic phosphate level were more and S. alkaline phosphatase level were less in supplemented group but no significant change was observed between two groups. The mean of weight, length and head circumference were also comparable at enrollment between two groups. At 6 weeks’ growth velocity considering weight, length and head circumference were more at supplemented group but no significant change were observed between two groups. Conclusion: Infants of supplemented group showed better growth velocity and lower incidence of metabolic bone disorders than non-supplemented group. But this difference between supplemented group and non-supplemented group were not statistically significant. However, his study does not provide any evidence to suggest the effectiveness of supplementary calcium and phosphorus in osteope

MDCT-QCT, QUS, and DXA in healthy adults: An intermodality comparison.

Background: Cortical deceleration is the main reason for bone loss at peripheral sites. It was suggested that when peripheral bones were assessed for osteoporosis, management and therapy can be administered early. The main aim of this study was to assess the relationships between the central and peripheral measurements at different skeleton bone sites (spine, femur, forearm, tibia, and calcaneus) with available modalities: DXA, QUS, and MDCT-QCT. Methods: The volunteers recruited in this study did not have any history or evidence of metabolic bone disease. Blood test and DXA measurements were used as inclusion criteria to select 40 healthy participants. The selected volunteers underwent 3 imaging modalities: QCT, DXA, and QUS. DXA-based measurements were made on 3 sites, including spine, femur, and forearm. QCT and QUS measurements were done for distal of tibia and calcaneus bones, respectively. The extracted parameters from the 3 modalities were analyzed using a bivariate (Pearson) correlation (r) in statistical software. Results: The results showed moderate to good correlations between spongy bones in central and peripheral sites from all the modalities. However, there was no correlation between MDCT measures and central bone values. According to correlations between different peripheral sits, aBMD of 33% radius and trabecular vBMD in 38% distal tibia showed weak but significant relationship between peripheral bones (r=-0.342, p=0.044). Conclusion: The findings demonstrated how bones in central and peripheral sites were correlated. Multimodality imaging was used in this group of healthy volunteers. Also, it was found that QCT-based MDCT needs more optimization and requires further investigations.

114 Opportunistic Screening of Bone Mineral Density With CT Scans in Chronic Pancreatitis

INTRODUCTION: Osteoporosis and fragility fractures have been repeatedly shown to increase morbidity, mortality and socioeconomic costs. Chronic pancreatitis (CP) has multiple shared risk factors and complications that promote an imbalance in bone mineralization and remodeling which ultimately contributes to a high prevalence of metabolic bone disease. However, in the absence of societal guidelines regarding screening, dual-energy x-ray absorptiometry (DEXA) scans are not routinely performed and are not universally covered by insurance. While DEXA scan is the gold standard to assess bone mineral density, a Computed Tomography (CT) L1 vertebral density less than 135 Hounsfield Units (HU) has been validated to diagnose osteoporosis in the general population. The aim of this proof of concept study was to determine if the CT L1 vertebral threshold of 135 HU is also valid as an opportunistic screening cut-point for osteoporosis in chronic pancreatitis patients. METHODS: We selected patients with a definitive diagnosis of CP (according to the American Pancreatic Association guidelines) who were enrolled into The Ohio State Wexner Medical Center Pancreas Disease Biobank. Basic demographic information was abstracted including age, sex, race, BMI, smoking and alcohol history. Pertinent laboratory values and imaging studies, including DEXA scans, were also obtained from these patients. Baseline L1 vertebral HU values on CT scans were determined for BMD assessment (Pickhardt et al, Annals of Internal Medicine 2013). RESULTS: Sixty-four patients with definite CP were identified, including 27 (42%) with a CT and DEXA scan. Of these, 15/27 (56%) had evidence of metabolic bone disease (z-score &lt; −1.5), including 15% with osteoporosis. Mean L1 HU value in those with osteoporosis was 106. There was a statistically significant association between osteoporosis (z score &lt; −2.5) and the CT L1 HU threshold of 135 (P = 0.025, positive likelihood ratio of 8.62, PPV 60%). The L1 HU threshold of 135 had sensitivity of 75% and specificity of 91.3% for osteoporosis and a NPV of 95.45%. CONCLUSION: CT scans performed during routine clinical care of patients with CP may be useful for opportunistic screening for osteoporosis using L1 HU attenuation, especially at a threshold of 135. Larger sample sizes of patients are needed to further develop risk stratification models in CP considering other clinical risk factors.

Radiographic and histological evidence of metabolic bone disease in gliding leaf frogs (Agalychnis spurrelli)

Bone alterations due to metabolic bone disease in captive animal populations can have a negative impact on repopulation and research initiatives. This investigation has the purpose of describing the principal radiographic and anatomopathological findings present in nine gliding leaf frogs (Agalychnis spurrelli) kept in captivity with alterations in their spines and long bones. The observed histopathological findings were in the canalis vertebralis, paraspinal muscle and long bones, and included deformed bones with alteration of the adjacent tissues, alterations in the ossification process, bone degeneration and resorption, decreased number of osteocytes and deposition of osteoid and fibrous material in the compact bone tissue. Additionally, the spinal cord showed compressed white matter, chronic meningitis in the duramater, alteration in the number of glial cells and loss of delimitation between the gray and white matter. Radiographical changes were found mainly in the long bones and included moth-eaten osteolysis, solid periosteal reaction, bone deformities, cortical tunneling and inflammation of adjacent soft tissues. Also, pathological fractures of the femur and urostyle were observed together with spinal column deviations with increased bone density.

A Cross-Sectional Study to Assess the Modulation of Wnt Inhibitors following Anti-Epileptic Drug Therapy and their Correlation with Vitamin D and Receptor Activator of Nuclear Factor κ B Ligand in Indian Women with Epilepsy.

Long-term anti-epileptic drug (AED) therapy compromises bone health. Although vitamin D deficiency is proposed to be involved, it alone is not held responsible. This accounts for investigating other mechanisms in bone accrual. Recent studies have shown modulation of inhibitors of wnt pathway, sclerostin and dickkopf-1 (DKK-1), in glucocorticoids-induced osteoporosis. We investigated whether AED monotherapy modulates wnt inhibitors in Indian women with epilepsy. Women of age > 20-40 years with the diagnosis of epilepsy and receiving AEDs (carbamazepine, valproate and levetiracetam) for at least a year were enrolled. The results were compared with age-matched healthy controls with no evidence of metabolic bone disease. Women undergoing treatment with AEDs (mean duration: 50.59 ± 37.929 months) exhibited higher serum sclerostin and receptor activator of nuclear factor κ B ligand (RANKL) and lower vitamin D (25-hydroxy vitamin D) and DKK-1 levels when compared to age-matched healthy controls. Sclerostin showed a positive correlation with RANKL, while DKK-1 presented no such relationship. However, no association was evident after adjusting for age, duration of treatment and total daily dose. Although a correlation between wnt inhibitors and RANKL could not be obtained, AEDs displayed changes in serum levels of wnt inhibitors in persons with epilepsy and hence these drugs may compromise bone health through a disturbance in wnt signalling mechanisms.

Radiographic diagnosis of metabolic bone disease in captive bred mountain chicken frogs (Leptodactylus fallax)

Asymptomatic captive bred and wild-caught mountain chicken frogs (Leptodactylus fallax) were radiographed for evidence of metabolic bone disease (MBD). All 22 captive bred frogs had multiple folding fractures of long bones, decreased bone density, and cortical thinning, whereas none of the 11 wild-caught frogs had any radiographic evidence of MBD. These findings suggest that the nutritional requirements of L. fallax need to be examined for captive management purposes.

Histomorphometric analysis of fracture healing cascade in acute osteoporotic vertebral body fractures

Background While fracture healing has been well characterised in long bones, there is scant data relating to this process in acute vertebral body fractures. Aim To characterise the histological process of fracture healing in acute osteoporotic vertebral body fractures using qualitative and quantitative bone histomorphometry. Subjects and methods Transpedicular bone biopsy was performed in patients undergoing percutaneous vertebroplasty. Undecalcified biopsy specimens were prepared from cores of cancellous bone harvested from vertebral bodies with MRI evidence of bone marrow oedema. These were analysed by light microscopy using grid analysis and defined using bone histomorphometry criteria. Normative data obtained from 5 age-matched volunteers without evidence of metabolic bone disease or osteoporosis was used for comparison. Results Adequate biopsy specimens were obtained in 72 of 90 patients (15 men and 57 women), mean age 75.6 years. All biopsies confirmed severe osteoporosis with reduced cancellous bone volume (mean of 13.5%; P < 0.001 compared to controls). The timing of biopsies varied from 1 to 24 weeks (median of 6 weeks) after the fracture event. There were 4 stages of fracture callus healing observed: Stage I in 17 (24%) patients, Stage II in 16 (22%), Stage III in 22 (30%) and Stage IV in 17 (24%). An overlap between the various stages was evident with 55 (76%) patients demonstrating at least 2 or more of the stages of fracture healing in the same biopsy specimen. The time interval since fracture event was the most important predictor of the stage of the fracture callus ( R = 0.32; P < 0.001). Conclusion Our data demonstrates a mixed fracture callus with overlapping of the various stages of fracture healing. This suggests that individual vertebra may be susceptible to multiple fractures over the course of the healing process.

Intracortical remodeling during human bone development—A histomorphometric study

Although intracortical bone remodeling is a key aspect of bone physiology, very little is known about this process during human bone development. In this study, we examined transiliac bone samples from 56 individuals between 1.5 and 22.9 years of age (31 female; tetracycline labeling present in 42 subjects) who did not have evidence of metabolic bone disease. Parameters of osteonal structure (osteon diameter, wall thickness, diameter of osteonal canals) and dynamic measures of intracortical remodeling were determined separately for the external and internal cortex. We found that measures of osteonal structure were independent of age. However, the percentage of osteons showing metabolic activity was lower in the older study subjects, corresponding to a slowdown in the turnover of cortical bone. Most dynamic parameters of bone metabolism were higher in the internal cortex than in the external cortex. Cortical porosity was negatively associated with age on the external, but not on the internal cortex. The bone forming activity that refills the remodeling cavities seemed to favor the side of the osteonal canal that faced towards the periosteum. In summary, intracortical remodeling activity varies markedly during bone development, and is slightly asymmetric between the two cortices of an iliac bone specimen. Remodeling during development is thus an age-dependent process that varies with location even within the same bone.

AH17: Increased risk of secondary hyperparathyroidism in African American after laparoscopic gastric bypass surgery

Metabolic bone disease is a potential complication of bariatric surgery. It is often undiagnosed, because of lack of physician and patient awareness. Abnormalities in parathyroid hormone (PTH) levels and vitamin D metabolism begin shortly after bariatric surgery; however, clinical evidence of metabolic bone disease may not be detected until years later. The aim of the study is to determine if African Americans patients have a higher risk to develop secondary hyperparathyroidism (HPT).

Cellular Activity on the Seven Surfaces of Iliac Bone: A Histomorphometric Study in Children and Adolescents

Transiliac cortical bone histomorphometry was performed in 56 metabolic bone disease-free individuals 1.5-22.9 years of age. During the growing years, the two cortices of an iliac bone specimen differ with regard to bone cell activity on their surfaces, probably reflecting a modeling drift. Standard bone histomorphometry in the clinical setting is typically limited to the analysis of cancellous bone. However, during the growth period, important changes occur also in the cortical compartment. Transiliac bone samples from 56 individuals between 1.5 and 22.9 years of age (25 male; tetracycline labeling present in 42 subjects) and without evidence of metabolic bone disease were analyzed. Each of the three bone surface types (periosteal, intracortical, endocortical) of each cortex was evaluated separately. Results were expressed relative to those obtained in trabecular bone. A significant increase in cortical width with age was detected only for the internal cortex. Porosity of the external cortex was highest in the 7- to 10.9-year age group and decreased thereafter, whereas there was no clear trend with age for the porosity of the internal cortex. Intracortical remodeling activity decreased after 14 years of age. Periosteal bone formation was very active until 13 years of age, but was close to zero in subjects above that age. As to endocortical surfaces, all bone surface-based parameters of bone formation were higher on the internal cortex than on the external cortex, whereas bone resorption parameters were higher on the external cortex. In growing subjects, the two cortices of an iliac bone specimen differ with regard to bone cell activity on their surfaces. These data raise fundamental questions about the regulation of bone cell activity in children and adolescents.

Comparison of mineral quality and quantity in iliac crest biopsies from high- and low-turnover osteoporosis: an FT-IR microspectroscopic investigation

Fourier-transform infrared microspectroscopy (FTIRM) allows analysis of mineral content, mineral crystal maturity and mineral composition at approximately 10-micron spatial resolution. Previous FTIRM analyses comparing 4-micron thick sections from non-decalcified iliac crest biopsies from women with post-menopausal osteoporosis, as contrasted with iliac crest tissue from individuals without evidence of metabolic bone disease, demonstrated significant differences in average mineral content (decreased in osteoporosis) and mineral crystal size/perfection (increased in osteoporosis). More importantly, these parameters, which vary throughout the tissue in relation to the tissue age in healthy bone, showed no such variation in bone biopsies from patients with osteoporosis. The present study compares the spatial and temporal variation in mineral quantity and properties in trabecular bone in high- and low-turnover osteoporosis. Specifically, six biopsies from women (n=5) and one man with high-turnover osteoporosis (age range 39-77) and four women and two men with low turnover osteoporosis (age range 37-63) were compared to ten "normal" biopsies from three men and seven woman (age range: 27-69). "High turnover" was defined as the presence of increased resorptive surface, higher than normal numbers of osteoclasts and greater than or equal to normal osteoblastic activity. "Low turnover" was defined as lower than normal resorptive surface, decreased osteoclast number and less than normal osteoblastic activity. Comparing variations in FTIR-derived values for each of the parameters measured at the surfaces of the trabecular bone to the maximum value observed in multiple trabeculae from each person, the high-turnover samples showed little change in the mineral: matrix ratio, carbonate: amide I ratio, crystallinity and acid phosphate content. The low-turnover samples also showed little change in these parameters, but in contrast to the high-turnover samples, the low-turnover samples showed a slight increase in these parameters, indicative of retarded, but existent resorption and formation. These data indicate that FTIR microspectroscopy can provide quantitative information on mineral changes in osteoporosis that are consistent with proposed mechanisms of bone loss.

Hypothesis: Fetal movement influences fetal and infant bone strength

Infants who present with multiple unexplained fractures in which there is no prior trauma, no radiographic evidence of metabolic bone disease, and no biochemical evidence of metabolic bone disease are almost always diagnosed as victims of child abuse, even though parents and caregivers deny wrongdoing. Such a diagnosis has far reaching implications for the infant and family. This article describes the clinical features of 65 such infants with multiple unexplained fractures in which the parents and caregivers deny wrongdoing and in which child abuse was diagnosed. These infants have the phenotype of temporary brittle bone disease that was described by Paterson. A striking observation in these young infants is the pregnancy history of decreased fetal movement. A hypothesis is suggested as an alternative explanation for the mechanism of these fractures in these infants--namely temporary brittle bone disease from fetal immobilization. This hypothesis states that fetal bone loading through fetal movement is essential for the formation of bones of normal strength. This hypothesis is an application of Frost's mechanostat/bone-loading model of bone physiology to the prenatal period of bone formation. This hypothesis explains many of the other observations about temporary brittle bone disease including the early onset of the fractures in the first several months of life, the lack of bruising, the lack of other internal organ injury, and the low risk profile of many of the parents for committing child abuse.

Elevated Serum Parathormone after Roux-en-Y Gastric Bypass

Abnormalities in calcium and vitamin D metabolism are observed early after gastric bypass, whereas clinical or biochemical evidence of metabolic bone disease might not be detected until many years after the procedure. The aim of the present study was to evaluate the impact of bariatric surgery on bone metabolism determined on the basis of postoperative laboratory changes in calcium, phosphorus, magnesium, alkaline phosphatase and parathormone (PTH) levels. 110 patients submitted to Roux-en-Y gastric bypass (RYGBP) were followed after surgery, and the following parameters were determined: intact PTH molecule (PTHi; chemiluminescence), alkaline phosphatase (colorimetric method), ionic calcium (selective electrode), phosphorus and magnesium (colorimetric method). Elevated serum PTHi levels were observed in 29% of the patients and hypocalcemia in 0.9% from the 3rd postoperative month and afterwards (3 to 80 months after surgery). There is a need for careful evaluation of bone metabolism and for routine calcium replacement after RYGBP.

The frequency of vitamin D deficiency in adults with Crohn's disease.

Vitamin D deficiency is a putative, pathogenic cofactor in the increase in osteopenia and osteoporosis seen in patients with Crohn's disease. To determine the frequency of low serum 25-hydroxy-vitamin D3 (25-OHD) levels and the associated alterations in bone mineral density in a cohort of adults with Crohn's disease. 25-OHD levels were determined in 242 consecutive patients with Crohn's disease seen in two tertiary inflammatory bowel disease referral centres. Bone mineral density was assessed by dual energy x-ray absorptiometry. Nineteen (8%) patients exhibited vitamin D deficiency (25-OHD less than 25 nmol/L) and 52 (22%) patients exhibited vitamin D insufficiency (25-OHD less than 40 nmol/L). Mean T-scores at the lumbar spine, femoral neck, total hip and ultradistal radius in the group with low 25-OHD did not differ from those of the normal 25-OHD group. Serum alkaline phosphatase and parathyroid hormone levels were higher in the low 25-OHD group than in the normal group. Decreased red blood cell (RBC) folate predicted low 25-OHD in male patients, while smoking, RBC folate and serum iron predicted low 25-OHD in female patients. The rate of low 25-OHD deficiency in the winter was significantly higher than that in the summer (11.9% versus 2.8%, respectively). Vitamin D-deficient Crohn's disease patients exhibit biochemical evidence of metabolic bone disease, without detectable differences in bone mineral density. Sunlight exposure, nutrition and smoking status were predictors of vitamin D deficiency in this patient cohort.

Incidental Diagnosis of Multiple Myeloma during Conservative Treatment for Vertebral Fracture

A 42-year-old male came to our pain clinic for consultation for the control of pain caused by compression fractures at T12 and L1. About 2 months ago, the patient had a T9 compression fracture after a trivial injury. We started to control the pain with epidural steroid injections and epidural patient controlled analgesia (peA). The patient got new fractures at T8 and L2, even though on bed rest. No evidence of metabolic bone disease or malignancy was noted on routine laboratory tests. Increased uptake of radioactivity at multiple vertebrae was shown on bone scan and the magnetic resonance imaging (MRI) finding was suspected to be an infiltrative bone marrow disease. Therefore, we consulted an oncologist for further evaluation, then the patient was diagnosed with multiple myeloma with bone marrow biopsy. This case report suggests that clinicians should consider the possibility of malignancy in the case of multiple compression fractures of vertebrae especially in young male patients.

Neonatal factors predicting childhood height in preterm infants: Evidence for a persisting effect of early metabolic bone disease?

Objectives: Preterm infants are known to remain small during childhood. We previously found that evidence of neonatal metabolic bone disease was associated with reduced length at 18 months. We aimed to further investigate factors predicting childhood height and to test the hypothesis that evidence of early metabolic bone disease is associated with reduced later height. Study design: A cohort of preterm infants was measured prospectively at 18 months (n = 765), 7.5 to 8 years (n = 772), and 9 to 12 years of age (n = 503). Results: Preterm infants remained short for their age and sex at all follow-ups. Later height was most strongly predicted by parental height and, at 9 to 12 years, by pubertal status. Neonatal factors associated with later height were birth weight SD score, maternal hypertension/toxemia, and a high peak plasma alkaline phosphatase during the neonatal period. After adjustment for these factors plus interim heights, height at 9 to 12 years was greatest in those who were tallest at 7.5 to 8 years, those who had shown the greatest increase in height percentile between 18 months and 7.5 to 8 years and, as expected, those who were pubertal, whereas children with a peak neonatal plasma alkaline phosphatase >1200 IU were significantly shorter. Conclusions: Childhood height in preterm infants is strongly influenced by genetic factors. However, biochemical evidence of metabolic bone disease during the neonatal period may have a long-term stunting effect persisting up to 12 years later, providing support for current practices that aim to prevent this condition. (J Pediatr 2000;137:668-73)