CHALLENGES IN ASSESSING BONE HEALTH IN EARLY INFANCY: A NARRATIVE REVIEW OF EXISTING TECHNOLOGIES

Giorgia Pepe¹Letteria Anna Morabito¹Domenico Corica^1*Tommaso Aversa^1*Virginia Beretta²Elena Scarpa²Chiara Petrolini²Andrea Dall'Asta³Federica Grassi²Anna-Mariia Shulhai⁴Anna Maria Papini⁵Maria Cristina Albertini⁶Silvia Carloni⁶Serena Benedetti⁶Giuseppe Maglietta⁷Matteo Puntoni⁷Caterina Caminiti⁷Tullio Ghi³Maria Elisabeth Street^4,8Serafina Perrone^2,4Malgorzata Gabriela Wasniewska¹

• ¹Department of Human Pathology in Adulthood and Childhood Gaetano Barresi, University of Messina, Messina, Italy
• ²Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children’s Hospital, Parma, Italy
• ³Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
• ⁴Department of Medicine and Surgery, University of Parma, Parma, Italy
• ⁵Department of Chemistry "Ugo schiff", University of Florence, Sesto Fiorentino, Italy
• ⁶Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
• ⁷Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
• ⁸Unit of Paediatrics, University Hospital of Parma, Parma, Italy

To date, no shared guidelines have been approved for the diagnosis and management of low bone mineral density (BMD), especially in early infancy. Therefore, there is an increasing demand for new methodologies to allow the assessment of bone health status in this specific cohort, which is exposed to several risk factors (e.g. maternal vitamin D deficiency, pregnancy-associated diseases, preterm birth and comorbidities, low birth weight, intrauterine growth restriction). Currently, the assessment of BMD in newborn and infants relies mainly on serum and urinary biochemical markers, in association with several technologies to measure bone mineral content, such as dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound (QUS) being traditionally used, despite many limitations. More recently, Radiofrequency Echographic Multi-Spectrometry (REMS) emerged as a promising tool in clinical practice for screening and monitoring BMD. Due to the radiation-free technology, an extremely ease of use, low costs, an excellent degree of sensitivity, specificity, and reproducibility, REMS technology has proven to be the gold standard technique in sensitive populations such as pregnant women, newborns and infants, allowing mass extended screening strategies. However, to date no validate cut-off reference for REMS in paediatric age are available. Future longitudinal studies on REMS methodology are needed to build reference standards and new shared algorithms, combining biochemical and instrumental data, for the diagnosis, management and treatment of decreased BMD before and after birth.