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Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences
  1. Amish Chinoy1,2,
  2. Mohamed Zulf Mughal1,2,
  3. Raja Padidela1,2
  1. 1 Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK
  2. 2 Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  1. Correspondence to Dr Raja Padidela, Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester M13 9WL, UK; Raja.Padidela{at}


Metabolic bone disease of prematurity (MBDP) is characterised by skeletal demineralisation, and in severe cases it can result in fragility fractures of long bones and ribs during routine handling. MBDP arises from prenatal and postnatal factors. Infants who are born preterm are deprived of fetal mineral accumulation, 80% of which occurs in the third trimester. Postnatally, it is difficult to maintain a comparable intake of minerals, and medications, such as corticosteroids and diuretic therapy, lead to bone resorption. With improvements in neonatal care and nutrition, the incidence of MBDP in preterm infants appears to have decreased, although the recent practice of administering phosphate supplements alone will result in secondary hyperparathyroidism and associated bone loss, worsening MBDP. Postnatal immobilisation and loss of placental supply of oestrogen also contribute to skeletal demineralisation. There is no single diagnostic or screening test for MBDP, with pitfalls existing for most radiological and biochemical investigations. By reviewing the pathophysiology of calcium and phosphate homeostasis, one can establish that plasma parathyroid hormone is important in determining the aetiology of MBDP – primarily calcipaenia or phosphopaenia. This will then direct treatment with the appropriate supplements while considering optimal physiological calcium to phosphate ratios.

  • parathyroid hormone
  • metabolic bone disease of prematurity
  • neonatology
  • calcium
  • phosphate

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  • Contributors AC (drafting and revising manuscript), MZM (revising manuscript) and RP (drafting and revising manuscript).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.

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