Osteopenia means a decrease in the amount of calcium (Ca) and phosphorus (P) in the bone. This can cause bones to be weak and brittle, and increases the risk for fractures.

During the last 3 months of pregnancy, large amounts of Ca and P are transferred from the mother to the baby for bone growth. If your baby was born prematurely, he or she may not receive the required amounts of Ca and P to properly form strong bones. Despite being fed breast milk with supplements or the use of special formulas, your premature infant receives much less calcium and phosphorous than if he was still in the womb.

If your baby requires long-term IV nutrition, even less Ca and P will be received than from formula feedings. An added problem is that very premature babies lose much more phosphorus (P) in their urine than do term infants. If your baby is on diuretics (water� drugs such as furosemide or lasix�) or steroids he may also lose more calcium (Ca) in the urine than normal.

Vitamin D helps with the absorption of Ca from the intestine and kidney. If babies do not receive or make enough vitamin D, they will be unable to properly absorb calcium and phosphorous. In most premature babies, too little Vitamin D is not the problem, the problem is inadequate intake or excessive loss of Ca and P. However, if your baby has a liver problem know as cholestasis,� he may have problems with inadequate Vitamin D.

Physical activity is also very important to the development of strong bones. While in the womb, fetal activity increases during the last 3 months of pregnancy and this activity is thought to be important for bone development. Most very premature infants have limited physical activity, which, along with decreased Ca and P, may contribute to weak bones.

Most premature infants less than 30 weeks gestation have some degree of osteopenia, but will not have any physical indication of this. Infants with severe osteopenia may have evidence of decreased movement or swelling of an arm or leg due to an unknown fracture.

Osteopenia is more difficult to diagnose in premature infants than in adults. The most common tests used to diagnose osteopenia of prematurity include:

• X-rays: Your doctor will look for evidence of thin bones or fractures.
• Blood tests: Your doctor may monitor levels of Ca and P in the blood. Also a specific protein in the blood called Alkaline Phosphatase� may be measured � very high levels suggest that osteopenia is present.

Newer tests are being investigated to monitor osteopenia including ultrasound and special x-ray absorption devices.

The best treatment is prevention. This may be difficult to achieve if your baby is very immature (less than 28 weeks). Therapies that appear to improve bone strength include:

• Give extra Ca and P supplementation to breast milk.
• Use specially formulated premature formulas when breast milk is not available.
• Maximize the intake of Ca and P in IV nutritional fluids.
• Early initiation of a daily physical activity program may be helpful. If your baby has liver problems, additional Vitamin D supplementation may be needed.

If your premature baby has a fracture it will usually heal with use of a splint on the broken bone, gentle handling, and increased attention to dietary intakes of Ca, P, and Vitamin D. There may be an increase risk for fractures throughout the first year of life for very premature infants with osteopenia of prematurity.

Recent long-term studies suggest that very-low-birth weight is a significant risk factor for osteopenia (usually called osteoporosis�) later in adult life. Whether aggressive efforts to treat or prevent osteopenia of prematurity in the NICU can decrease this risk as an adult is unknown.