Parathyroid hormone as a marker for metabolic bone disease of prematurity

J Perinatol. 2014 Oct;34(10):787-91. doi: 10.1038/jp.2014.97. Epub 2014 May 29.


Objective: To compare parathyroid hormone to alkaline phosphatase as a serologic marker for metabolic bone disease (MBD) in preterm infants.

Study design: An 18-month prospective observational study in neonates with birth weight < 1250 g. Simultaneous serum parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium (Ca) and phosphorus (P) were measured at scheduled intervals during hospitalization. At 6 weeks of age, MBD was evaluated using knee radiographs. Comparisons were analyzed using multivariate logistic regression, receiver operating characteristic (ROC) curves, χ² and Student t-test.

Result: Fourty-nine infants were included in the study: 7 with severe and 42 with mild MBD. Using ROC curves, at 660 U l⁻¹ ALP had a sensitivity of 29% and specificity of 93% for severe MBD, while a cutoff point of 180 pg ml⁻¹ gave PTH a sensitivity of 71% and specificity of 88%. Infants with severe bone disease had a lower birth weight, 21-day serum P, an increased use of glucocorticoids and caffeine, and more likely to have major neonatal morbidities.

Conclusion: PTH is an early marker with better sensitivity than ALP in screening for MBD. At 3 weeks chronologic age, a PTH level > 180 mg dl⁻¹ or a P level <4.6 pg ml⁻¹ yielded a sensitivity of 100% and specificity of 94% for severe MBD [corrected].

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Alkaline Phosphatase / analysis
  • Alkaline Phosphatase / blood*
  • Analysis of Variance
  • Biomarkers / blood
  • Bone Diseases, Metabolic / blood
  • Bone Diseases, Metabolic / diagnosis*
  • Bone Diseases, Metabolic / diagnostic imaging
  • Cohort Studies
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Intensive Care Units, Neonatal
  • Male
  • Parathyroid Hormone / analysis
  • Parathyroid Hormone / blood*
  • Prospective Studies
  • ROC Curve
  • Radiography
  • Sensitivity and Specificity


  • Biomarkers
  • Parathyroid Hormone
  • Alkaline Phosphatase