Bone health starts before birth! A baby’s bones start forming in the womb, relying on maternal nutrition and overall health for proper development. For preterm babies, this process is disrupted, increasing the risk of metabolic bone disease (MBD) or osteopenia. These are conditions that lead to weaker bones, a higher risk of fractures, and slower growth.

Why Are Preemies at Risk?

During the last trimester, babies store up essential minerals like calcium and phosphorus to build strong bones. Preemies miss out on this crucial period, making their bones more fragile. Other risk factors include:

🦴 Early Birth & Mineral Deficiency: Since most bone development happens in the final trimester, preemies are born with lower levels of calcium and phosphorus, making their bones more fragile.

🦴 Health Challenges: Conditions like necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and infections can affect a baby’s ability to absorb nutrients needed for bone growth.

🦴 Low birth weight (especially very low or extremely low birth weight babies).

🦴 Limited Movement & Long Hospital Stays: Preemies often spend weeks in the NICU with restricted movement, which can slow bone strengthening.

🦴 Nutritional Gaps: Many preemies rely on IV nutrition (total parenteral nutrition or TPN), which lacks the optimal levels of calcium and phosphorus found in the womb.

🦴 Vitamin D Deficiency: Both maternal and infant vitamin D levels play a role in bone health, and preemies are more likely to be deficient.

How Do We Keep Preemie Bones Boo-tiful?

The good news is that osteopenia can often be prevented or managed with the right care, such as:

Bone to Pick: Why Do Strong Bones Matter?

Strong bones in infancy set the stage for a lifetime of good bone health! Preemies with osteopenia need extra care to avoid spooky surprises like osteoporosis and fractures later in life. By focusing on prevention and early treatment, we can give these little pumpkins the best chance to grow into the strongest and healthiest little skeletons. 🎃

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REFERENCES

1. SickKids Staff. (2025, January 13). Bone health in premature babies. AboutKidsHealth. https://www.aboutkidshealth.ca/bone-health-in-premature-babies
2. Perrone, S., Caporilli, C., Grassi, F., Ferrocino, M., Biagi, E., Dell’Orto, V., Beretta, V., Petrolini, C., Gambini, L., Street, M. E., Dall’Asta, A., Ghi, T., & Esposito, S. (2023). Prenatal and Neonatal Bone Health: Updated Review on Early Identification of Newborns at High Risk for Osteopenia. Nutrients, 15(16), 3515. https://doi.org/10.3390/nu15163515