Work

Interventions for metabolic bone disease of prematurity: A systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Introduction: Metabolic bone disease of prematurity (MBDP) affects up to 30 % of very low birth weight infants; however, evidence regarding prevention and treatment strategies remains limited. We aimed to evaluate the efficacy and safety of nutritional, mechanical, and pharmacological interventions for MBDP. Methods: Following PRISMA 2020 guidelines, we searched five databases from inception to May 5, 2025, for studies evaluating interventions for MBDP in preterm infants (<37 weeks or <1500g). Primary outcomes included MBDP incidence, bone mineral density, and safety profiles. Random-effects meta-analyses, trial sequential analysis (TSA), and GRADE assessments were conducted. Results: Eighteen studies (1577 infants) from ten countries met inclusion criteria. Nutritional prophylaxis significantly reduced MBDP incidence by 54 % (risk ratio [RR] = 0.46, 95 % confidence interval [CI] 0.30-0.68, P-value<0.001), with early calcium/phosphorus supplementation achieving 74-84 % risk reduction. TSA confirmed conclusive evidence, with cumulative Z-score (-5.99) crossing the O'Brien-Fleming boundary at 270.9 % of required information size. Number needed to treat was five at 40 % baseline risk. Mechanical interventions improved bone mineral content by 28 % (P-value<0.01), quantitative ultrasound speed-of-sound (mean difference [MD] = 75.3 m/s, 95 % CI 45.2-105.4), and weight gain (MD = 5.11 g/kg/day, 95 % CI 3.95-6.27). Both interventions demonstrated favorable safety profiles, with mechanical protocols reporting no adverse events. Conclusions: Nutritional prophylaxis conclusively reduces MBDP incidence, while mechanical interventions effectively improve bone mineralization. Although no studies directly evaluated combined approaches, the complementary mechanisms of nutritional and mechanical interventions suggest that optimal prevention may involve integrating both strategies. Critical gaps persist in orthopedic management, necessitating future research on fracture protocols and surgical interventions.

Source: Metabolism Open

DOI: 10.1016/j.metop.2026.100445