Learn About Osteopenia

What is the definition of Osteopenia?

Osteopenia is a decrease in the amount of calcium and phosphorus in the bone. This can cause bones to be weak and brittle. It increases the risk for broken bones.

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What are the alternative names for Osteopenia?

Neonatal rickets; Brittle bones - premature infants; Weak bones - premature infants; Osteopenia of prematurity

What are the causes of Osteopenia?

During the last 3 months of pregnancy, large amounts of calcium and phosphorus are transferred from the mother to the baby. This helps the baby grow.

A premature infant may not receive the proper amount of calcium and phosphorus needed to form strong bones. While in the womb, fetal activity increases during the last 3 months of pregnancy. This activity is thought to be important for bone development. Most very premature infants have limited physical activity. This may also contribute to weak bones.

Very premature babies lose much more phosphorus in their urine than do babies that are born full-term.

A lack of vitamin D may also lead to osteopenia in infants. Vitamin D helps the body absorb calcium from the intestines and kidneys. If babies do not receive or make enough vitamin D, calcium and phosphorous will not be properly absorbed. A liver problem called cholestasis may also cause problems with vitamin D levels.

Water pills (diuretics) or steroids can also cause low calcium levels.

What are the symptoms of Osteopenia?

Most premature infants born before 30 weeks have some degree of osteopenia, but will not have any physical symptoms.

Infants with severe osteopenia may have decreased movement or swelling of an arm or leg due to an unknown fracture.

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What are the current treatments for Osteopenia?

Therapies that appear to improve bone strength in infants include:

  • Calcium and phosphorus supplements, added to breast milk or IV fluids
  • Special premature formulas (when breast milk is not available)
  • Vitamin D supplementation for babies with liver problems
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What is the outlook (prognosis) for Osteopenia?

Fractures will most often heal well on their own with gentle handling and increased dietary intakes of calcium, phosphorus, and vitamin D. There may be an increased risk for fractures throughout the first year of life for very premature infants with this condition.

Studies have suggested that very low birth weight is a significant risk factor for osteoporosis later in adult life. It is yet unknown whether aggressive efforts to treat or prevent osteopenia of prematurity in the hospital after birth can decrease this risk.

What are the latest Osteopenia Clinical Trials?
Enteral Zinc to Improve Growth in Infants at Risk for Bronchopulmonary Dysplasia
Summary: Multiple factors contribute to growth failure in infants with BPD, including poor nutrient stores, inadequate intake, increased losses, and increased needs. Furthermore, compared to infants without BPD, those with BPD have increased resting metabolic rates and energy expenditure. Growth deficits manifest as lower weight, length, and head circumference, as well as changes in body composition. These...
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Vitamin D and Health Outcomes in Preterm Born Population -A Cohort and an Intervention Study of Vitamin D on Health Outcomes of Bones, Teeth, Muscles, Heart, and Lungs in Children and Adults Born Preterm in Northern Finland
Summary: Improved survival of very preterm newborn population during the last decades has challenged us neonatologists to study and improve nutritional practices including vitamin D (VitD) supplementation. However, long term outcome in this aspect has not been researched in well documented preterm populations. As VitD has receptors in almost all human cells it modulates growth of many organs. Therefore I s...
What are the Latest Advances for Osteopenia?
Effect of physiotherapy on the promotion of bone mineralization in preterm infants: a randomized controlled trial.
Summary: Effect of physiotherapy on the promotion of bone mineralization in preterm infants: a randomized controlled trial.
Effect of physical therapy on bone remodelling in preterm infants: a multicenter randomized controlled clinical trial.
Summary: Effect of physical therapy on bone remodelling in preterm infants: a multicenter randomized controlled clinical trial.
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Expert consensus on clinical management of metabolic bone disease of prematurity (2021).
Summary: Expert consensus on clinical management of metabolic bone disease of prematurity (2021).
Who are the sources who wrote this article ?

Published Date: December 10, 2021
Published By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Abrams SA, Tiosano D. Disorders of calcium, phosphorus, and magnesium metabolism in the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 87.

Koves IH, Ness KD, Nip A S-Y, Salehi P. Disorders of calcium and phosphorus metabolism. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 95.