Causes and risk factors
A variety of factors in combination causes this condition. Usually during the third trimester the baby needs a lot of minerals and nutrition for the growth of the bones. These nutrients and minerals are transferred from the mother to the baby. The placenta plays an important role for this supply. However, in case of premature birth, there is lack of this uptake of minerals and nutrients which affects the bone mineralization. Chronic damage to the placenta is another contributing factor in mothers who suffer from placental infection or with chorioamnionitis; demineralization is seen in such babies. Low intake of calcium and vitamin D by mother also leads to osteopenia in babies. Absorption of calcium is also hampered due to certain medications like steroids and diuretics.
Clinical presentation:
In initial case, the patient remains asymptomatic until severe demineralization occurs. Babies who are born before 30 weeks do posses osteopenia; however, there are no physical complaints seen. Over time particularly between the ages of 5-11 years, complaints are seen. The patient can present with skull deformity. Thickening of the costochondral junction is seen. There occurs easy fracture of ribs, wrist, and long bones. Softening of the tissues occur. Fracture of ribs affect respiration, causing distress and leading to pulmonary changes. Swelling of upper and lower extremities is seen.
Investigations:
Diagnosis is done on the basis of the symptoms narrated by the parents. A local examination is carried out by the pediatric doctor. Certain physical tests are conducted. A neurological evaluation is also done. Measuring the serum calcium, phosphate, and alkaline phosphate levels is diagnostic. Increased level of phosphate is seen. Along with this x-ray of the affected bone and other imaging tests like CT scan or MRI is done. A DEXA scan is a diagnostic tool to measure bone density.
Treatment:
The treatment plan consists of administration of vitamin D supplements, along with calcium and phosphorus. Special baby formula foods are started. Along with this, gentle body massage or passive exercise is also advised. In cases of fracture, appropriate cast application is done and several therapies are adopted which will promote healing.
Other Modes of treatment:
Physical exercises under a trained physiotherapist will help to strengthen the muscles and improve flexibility.
Complications:
Babies who have osteopenia are at higher risk for developing osteoporosis. Also, these children are more prone to fractures during the first year of their life.
When to contact a doctor:
Seek an advice from an orthopedic doctor if any child complains of recurrent episode of fractures or bony deformity in a weak child.
System Involved: Musculoskeletal system, respiratory system
Organ involved: Bones, muscles, nerves, lungs
