Metabolic Bone Disease of Prematurity: current knowledge, controversies, and research priorities

CPD Questions: Metabolic Bone Disease of Prematurity

Answer all 15 questions after reading the article. A minimum of 12 correct answers is required to pass.

1. 1. Which of the following statements is not true?

   A. Even though the incidence of MBDP is decreasing, it has been reported as high as 23% in VLBW infants.B. Even though the incidence of MBDP is decreasing, it was reported in 50% of ELBW infants by Mitchell et al in 2009.C. The decreasing incidence of MBDP from 1987 to 2009 may be attributed to human milk fortification.D. Radiological rickets was reported by Lyon et al in approximately 50% of ELBW infants.

2. 2. Peak fetal calcium and phosphate accretion occurs during which gestational period?

   A. 24–28 weeksB. 28–32 weeksC. 32–36 weeksD. 36–40 weeks

3. 3. Which hormone increases in response to the postnatal decline in serum calcium?

   A. CalcitoninB. InsulinC. Growth hormoneD. Parathyroid hormone

4. 4. According to the review, which prenatal condition can impair placental phosphate transport and increase MBDP risk?

   A. PolyhydramniosB. Placental insufficiencyC. Gestational diabetesD. Maternal obesity

5. 5. Which postnatal factor does not have a high relative risk for MBD?

   A. Delayed enteral feedingB. Glucocorticoid therapyC. Unfortified human milkD. Placental insufficiency

6. 6. Prolonged parenteral nutrition becomes a significant risk factor for MBDP after approximately:

   A. 1 weekB. 2 weeksC. 3 weeksD. 4 weeks

7. 7. Which medication class increases renal calcium losses and may contribute to MBDP?

   A. Proton pump inhibitorsB. Loop diureticsC. Beta blockersD. ACE inhibitors

8. 8. Which biochemical marker is considered the earliest indicator of disrupted mineral metabolism?

   A. HypophosphataemiaB. ALPC. HypocalcaemiaD. Vitamin D deficiency

9. 9. According to the review, radiological evaluation should be considered when ALP exceeds:

   A. 500 IU/LB. 700 IU/LC. 800 IU/LD. 1200 IU/L

10. 10. In detecting low bone mineral density, a combination of ALP >900 IU/L and phosphate <1.8 mmol/L has been reported to provide:

    A. 73% sensitivity and 74% specificityB. 100% specificity and 70% sensitivityC. 74% specificity and 73% sensitivityD. 100% sensitivity and 70% specificity

11. 11. According to the AAP, routine MBDP screening should:

    A. Be considered for all infants with a birth weight < 2500g and begin at 4 to 6 weeks after birthB. Be considered for infants with a gestational age of < 28 weeks and begin at 2 to 3 weeks after birthC. Be considered for infants with a birth weight < 1500g and begin at 2 to 3 weeks after birthD. Be considered for infants with a gestational age of < 28 weeks and begin at 4 to 6 weeks after birth

12. 12. According to the AAP Committee on Nutrition, recommended enteral vitamin D provision for VLBW infants is approximately:

    A. 100–200 IU/dayB. 200–400 IU/dayC. 100–200 IU/kg/dayD. 200–400 IU/kg/day

13. 13. Which adjunct therapy showed promise in infants with MBDP and secondary hyperparathyroidism?

    A. BisphosphonatesB. CalcitoninC. CalcitriolD. Growth hormone

14. 14. Which urinary marker has a high specificity for a phosphate deficiency?

    A. Tubular Reabsorption of CalciumB. Tubular Reabsorption of ProteinC. Tubular Reabsorption of PhosphateD. Urinary Phosphate

15. 15. Which research priority is identified as one of the most urgent needs in the field?

    A. Establishing standardized terminology and diagnostic criteriaB. Investigating novel therapeutic approachesC. Developing new vitamin D analoguesD. Developing new human milk fortifiers