Breast milk intake, intact parathyroid hormone, and %tubular phosphate reabsorption as predictors of bone mineral density at term-equivalent age in very preterm and/or low-birth-weight infants: A prospective cohort study
In brief
Greater fortified breast milk intake predicts higher bone density at term
In a cohort of 105 infants born up to 31 weeks or up to 1500 g, higher intake of fortified breast milk was independently associated with greater bone mineral density at term-equivalent age, while elevated intact parathyroid hormone at four weeks predicted lower density. Early monitoring of iPTH (or % tubular phosphate reabsorption) together with optimized milk fortification may help prevent metabolic bone disease in this high-risk group.
- Journal
- Early human development (Q1)
- Published
- 31 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Nao Takami, Yuichiro Sugiyama, Yoshihiro Tanahashi, Tomoki Ueda, Azuma Ikari, Sho Narahara, et al.
- PMID
- 42705182
- DOI
- 10.1016/j.earlhumdev.2026.106655
Why clinicians should know about it
- Picked for Neonatology (top studies of the week, 13 September 2026): Breast milk intake predicts bone density in preterms
Abstract
BACKGROUND: Predicting and preventing metabolic bone disease (MBD) in preterm infants remains challenging. AIMS: To evaluate the associations of bone mineral density (BMD) with fortified breast milk intake, and biochemical markers, including intact parathyroid hormone (iPTH), and %tubular phosphate reabsorption (%TRP). STUDY DESIGN: A prospective observational study conducted at a single tertiary center in Japan. SUBJECTS: Infants born at ≤31 weeks of gestation and/or birth weight ≤ 1500 g from August 2018 to August 2020. OUTCOME MEASURES: Cord blood iPTH and 25-hydroxyvitamin D, weekly serum iPTH, alkaline phosphatase (ALP), and %TRP were measured until term-equivalent age (TEA). BMD at TEA was assessed using dual-energy X-ray absorptiometry. Associations between clinical and biochemical variables and BMD were analyzed. RESULTS: Of 137 infants screened, 105 were included in the analysis. Higher breast milk intake was positively correlated with BMD, whereas elevated iPTH levels and lower %TRP at 3-8 weeks were negatively correlated with BMD. In multivariable regression analysis, birth weight and breast milk intake were positively correlated with BMD, whereas iPTH levels at 4 weeks were negatively associated. A linear mixed-effects model confirmed this longitudinal association. Gestational age, ALP, and 25-hydroxyvitamin D levels were not associated with BMD. CONCLUSION: Lower breast milk intake and elevated iPTH levels are indicators of reduced BMD at TEA in very preterm and very-low-birth-weight infants. %TRP may serve as a practical alternative marker, when iPTH measurements are unavailable. Early monitoring of iPTH and/or %TRP, combined with optimized fortified breast milk intake, may support bone health in this high-risk population.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.