Background Metabolic bone disease is a common condition among premature Neonates. The aim of this study was to determine the impact of calcium and phosphorus on radiological and biochemical character osteopenia in premature neonates.

Methods This trial was done in forty premature Neonates over a period of six months in the All these babies are fed with breast milk, and 400 units of vitamin D daily They, randomly divided into two groups. Half of these babies received supplement of Calcium (45 mg/kg/day) and phosphorus (24mg/kg/day).

Serum calcium, phosphorus, and alkaline phosphatase with growth parameters (including weight, height, and head circumference) was measured every two weeks. At the end of this time wrist x-ray for evaluating of osteopenia was done. The collected data was analyzed with SPSS 11.5.

Results Radiological changes characteristic of osteopenia have been found in 40% (8 cases) of infants in the case group and 65% (13 cases) of infants in the control group (P= 0.113). Serum calcium, phosphorus, and alkaline phosphatase levels was not statistically different (P>0.05). Weight gain was similar in both groups (P= 0.097). but, linear and head circumference rise in the case group were significantly greater than control group (P= 0.002 and P= 0.015, respectively).

Conclusion Calcium and phosphorus supplementation in pre-term breast-fed infants were seem to be effective on prevention of osteopenia and improvement of growth. Thus, we recommend oral calcium and phosphate supplement addition accompanying with breast-feeding in premature neonate.