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Observational Study
. 2016 Sep;95(37):e4837.
doi: 10.1097/MD.0000000000004837.

Serial serum alkaline phosphatase as an early biomarker for osteopenia of prematurity

Enas A A Abdallah  1 , Reem N Said, Dalia S Mosallam, Eman M I Moawad, Naglaa M Kamal, Mohammed G E-D Fathallah
Affiliations
Observational Study

Serial serum alkaline phosphatase as an early biomarker for osteopenia of prematurity

Enas A A Abdallah et al. Medicine (Baltimore). 2016 Sep.

Abstract

Metabolic bone disease of prematurity is a condition characterized by reduction in bone mineral content (osteopenia). It is a problem faced by very low birth weight (VLBW) infants because of lack of fetal mineralization during the last trimester. Our aim was to assess serum alkaline phosphatase (ALP) level as an early biomarker for osteopenia in premature infants and to estimate an optimal cutoff value of serum ALP at which osteopenia is detected radiologically in premature newborns.This prospective study was conducted on a cohort of 120 newborn infants of both sex of ≤34 weeks' gestational age and <1500 g birth weight. Two blood samples, from each infant on at least 2 consecutive weeks, were reported for calcium, phosphorus, and ALP. Evidence of osteopenia was evaluated radiologically by performing wrist/knee x-ray.Sixteen infants (13.3%) had evidence of osteopenia in x-ray, whereas 104 infants (86.7%) were nonosteopenic and all the osteopenic infants were <1000-g birth weight. Birth weight and gestational age were significantly inversely related to serum ALP levels. Both samples showed statistically significantly higher mean ALP level in osteopenic than nonosteopenics (P < 0.001, and P < 0.001 respectively). There was no constant value of serum ALP related to radiologic evidence of osteopenia. However, the optimal cutoff value of serum ALP at which osteopenia is detected is 500 IU/L with 100% sensitivity and 80.77% specificity.High levels of ALP can be considered a reliable biomarker to predict the status of bone mineralization and the need for radiological evaluation in premature infants particularly those <1000-g birth weight and <32 weeks' gestation.

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Conflict of interest statement

The authors have declared no conflict of interest.

Figures

Figure 1
Figure 1
(A) Male infant, 30 weeks of gestational age, 1000-g birth weight with evidence of osteopenia in knee x-ray (reduced bone density and widening of epiphyseal ends). (B) Female infant, 30 weeks of gestational age, 1000-g birth weight with evidence of osteopenia in wrist x-ray reduced bone density with widening and cupping of epiphyseal ends).
Figure 2
Figure 2
Receiver-operating characteristic curve analysis for alkaline phosphatase in detecting osteopenia.
See this image and copyright information in PMC

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