Can high doses of Vitamin D in prematurely born babies cause osteopenia?

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ALP (Alkaline Phosphatase) values are abnormal but improving since the optimal cut-off value of serum ALP is 500 IU/L. The ALP values are still so high due to metabolic bone disease osteopenia caused because of prematurity. This is a problem faced by very low birth weight infants because of a lack of fetal mineralization in the last trimester of the mother's pregnancy. Osteopenia of prematurity is due to the diminished bone mineral content, mainly because of diminished minerals stored in premature infants that may be exaggerated by increased mineral requirements in the neonatal period. Serum ALP is a marker for bone turnover, so there is no antidote as such for it. High levels indicate increased bone cellular activity, and when reaching more than 700 to 750 IU/L, they are linked to osteopenia. I suggest you consult a specialist and, with their consent, continue giving vitamin D drops- 400 IU (four drops per day). Continue giving milk formula for low birth weight infants. There is no need for extra phosphate supplements. Due to excess vitamin D, hypercalcemia can be observed. It is necessary to provide some sun exposure daily to the baby, and then there will be no need for supplements. Also, most importantly, you must see a pediatric gastroenterologist to rule out liver diseases because of high ALP, which is a probability, although much less than metabolic bone disease-osteopenia. Assessment of risk is by knee and wrist X-rays and follow-up of the same.

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The ALP is abnormal but not necessarily osteopenia. It is better to rule out the liver as a cause and not wait. The milk fortifier does contain good amounts of vitamins needed by your baby, so you do not need any additional supplements, but if your child is more than four weeks old, then no need for this fortifier as well. I suggest that you test your child for vitamin D levels. Hold milk fortifier and try sun exposure for your baby to prevent hypercalcemia. As it is, milk fortifier should be given only till the baby is four weeks old from the expected due date of birth. Breast milk is enough for your child as it contains appropriate amounts needed for the child.