Evidence for Exercise-Induced Bone Formation in Premature Infants

D. Nemet; T. Dolfin; I. Litmanowitz; R. Shainkin-Kestenbaum; M. Lis; A. Eliakim

doi:10.1055/s-2002-20134

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2002; 23(2): 82-85
DOI: 10.1055/s-2002-20134

Physiology and Biochemistry

Evidence for Exercise-Induced Bone Formation in Premature Infants

D. Nemet¹ , T. Dolfin¹ , I. Litmanowitz¹ , R. Shainkin-Kestenbaum¹ , M. Lis¹ , A. Eliakim¹

¹Departments of Pediatrics, and Neonatal Intensive Care Unit, Meir General Hospital, Kfar-Saba, The Sackler School of Medicine, Tel-Aviv University, Israel

Abstract

We assessed the effect of a four weeks exercise training intervention on bone turnover markers in premature infants. Twenty-four very low birth weight premature infants were matched for gestational age, birth weight, gender, as well as for corrected age and weight at initiation of the study. Then the subjects were randomly divided into an exercise (n = 12) and a control group (n = 12). Exercise consisted of passive range of motion exercise with gentle compression of both the upper and lower extremities lasting 5 - 10 minutes each day, 5 days per week for 4 weeks [18]. This protocol has been shown to increase bone mineral density in premature infants. Bone formation was assessed by measurements of circulating bone specific alkaline phosphatase (BSAP) and the C-terminal procollagen peptide (PICP). Bone resorption was determined by serum measurements of C- terminal cross-links telopeptide of type-I collagen (ICTP). Training led to a significant (P < 0.05) increase in weight gain (767 ± 49 versus 586 ± 24 gr in trained and control premature infants, respectively); and to a significant increase in BSAP (37.2 ± 14.6 versus 4.1 ± 8.4 % in trained and control premature infants, respectively). PICP increased also following exercise (34.6 ± 18.9 versus 5.4 ± 9.1 % in trained and control subjects, respectively), however, this increase was not statistically significant. Exercise led to a significant decrease in ICTP (-24.7±3.1 versus -5.5 ± 5.4 % in trained and control subjects, respectively). A relatively brief exercise intervention was associated with a biochemical evidence of bone formation in very low birth weight premature infants.

Key words

Premature · osteopenia · exercise · bone-turnover markers

Full Text

References

1 Anderson S A, Cohn S H. Bone demineralization during space flight. Physiologist. 1985; 28 212-217
2 Bowden L S, Jones C J, Ryan S W. Bone mineralization in ex-preterm infants aged 8 years. Eur J Pediatr. 1999; 158 658-661
3 Callenbach J C, Sheehan M B, Abramson S J, Hall R T. Etiologic factors in rickets of very low birth-weight infants. J Pediatr. 1981; 98 800-805
4 Committee on nutrition, American academy of pediatrics . Nutritional needs of low-birth weight infants. Pediatrics. 1985; 75 976-986
5 Delmas P D. Biochemical markers of bone turnover. Acta Orthop Scand. 1995; 266 76-182
6 Demarini D, Mimouni F B, Tsang R C. Rickets of prematurity. In: Fanaroff AA, Martin RJ (eds) Neonatal-Perinatal Medicine - Diseases of the Fetus and Infant. St. Louis; Mosby 1997: 1473-1476
7 Eliakim A, Brasel J A, Mohan S, Barstow T J, Berman N, Cooper D M. Physical fitness, endurance training, and the GH-IGF-I system in adolescent females. J Clin Endocrinol Metab. 1996; 81 3986-3992
8 Eliakim A, Raisz L G, Brasel J A, Cooper D M. Evidence for increased bone formation following a brief endurance-type training intervention in adolescent males. J Bone Miner Res. 1997; 12 1708-1712
9 Eriksen E F, Charles P, Melsen F, Mosekilde L, Risteli L, Risteli J. Serum markers of type I collagen formation and degradation in metabolic bone disease: correlation with bone histomorphometry. J Bone Mineral Res. 1993; 8 127-132
10 Eyre D R. Biochemical basis of collagen metabolites as bone turnover markers. In: Bilezikian JP, Raisz LG, Rodan GA (eds) Principles of Bone Biology. San Diego, CA, USA; Academic Press 1996 1st ed: 1135-1146
11 Falk B, Eliakim A, Dotan R, Liebermann D G, Regev R, Bar-Or O. Birth weight and physical ability in 5 to 8 yr old healthy children born prematurely. Med Sci Sport Exer. 1997; 29 1124-1130
12 Forbes G B. Calcium accumulated by the human fetus. Pediatrics.. 1976; 57 976-977
13 James J R, Condon P J, Truscott J, Horsman A, Arthur R. Osteopenia of prematurity. Arch Dis Child. 1986; 61 871-876
14 Kent N G. Markers of bone turnover. J Int Fed Clin Chem. 1997; 9 31-35
15 Leblanc A D, Schneider V S, Evans H J, Engelbretson D A, Krebs J M. Bone mineral loss and recovery after 17 weeks of bed rest. J Bone Miner Res. 1990; 5 843-850
16 Marcus R. Mechanisms of exercise effects on bone. In: Bilezikian JP, Raisz LG, Rodan GA (eds) Principles of Bone Biology. San Diego, CA, USA; Academic Press 1996 1st ed: 1135-1146
17 Mazess R B, Whedon G D. Immobilization and bone. Calc Tiss Res. 1983; 35 265-267
18 Moyer-Mileur L, Leutkermeler M, Boomer L, Chan G M. Effect of physical activity on bone mineralization in premature infants. J Pediatr. 1995; 127 620-625
19 Myburgh K H. Exercise and peak bone mass: An update. South African J Sport Med. 1998; 5 3-9
20 Naylor K E, Eastell R, Shattuck K E, Alfrey A C, Klein G L. Bone turnover in preterm infants. Pediatr Res. 1999; 45 363-366
21 Shiff Y, Eliakim A, Shainkin-Kestenbaum R, Arnon S, Lis M, Dolfin T. Measurements of bone turnover markers in premature infants. J Pediatr Endo Metab. 2001; 14 389-395
22 Slemenda C W, Miller J Z, Hui S L, Reister T K, Johnston C C. Role of physical activity in the development of skeletal mass in children. J Bone Miner Res. 1991; 6 1227-1233
23 Ziegler E E, O’Donnell A M, Nelson S E, Fomon S J. Body composition of the reference fetus. Growth. 1976; 40 329-341

M. D. A. Eliakim

Department of Pediatrics · Meir General Hospital

Kfar-Saba · Israel ·

Phone: +972 (9) 7472134

Fax: +972 (9) 7425967

Email: eliakim@internet-zahav.net