A narrative review of diabetic bone disease: Characteristics, pathogenesis, and treatment.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. 2. Arch Dis Child Fetal Neonatal Ed. 2019 Sep;104(5):F560-F566. doi: 10.1136/archdischild-2018-316330. Epub 2019 May 11. Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences. Chinoy A(1)(2), Mughal MZ(1)(2), Padidela R(1)(2). Author information: (1)Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK. (2)Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. 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. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. DOI: 10.1136/archdischild-2018-316330