Nutritional Strategies to Prevent Osteopenia of Prematurity: A Narrative Review with a Structured Search

Background: Preterm infants are at high risk of osteopenia of prematurity (OOP) due to interrupted third-trimester mineral accretion and early postnatal deficits. Aim: To synthesize recent evidence on nutritional strategies—especially early, fortified enteral feeding—to prevent OOP, with emphasis on early fortified enteral feeding. Design: Narrative review (SANRA‑guided) with a structured, reproducible search of PubMed, Scopus, and Google Scholar (January 2010 – June 2025); English/Polish; human neonatal data prioritized; mechanistic/animal data used for context. Findings: Across cohorts, early fortified human milk (typical Ca:P ≈ 1.6–1.8 with adequate protein and vitamin D) correlates with improved biochemical markers and lower OOP incidence versus unfortified feeds; prolonged PN (Parenteral Nutrition) and delayed enteral advancement are linked to higher OOP risk; unit‑level protocols that optimize Ca:P delivery from day 1 and routine HMF (Human Milk Fortifier) use reduce MBD incidence. Evidence is heterogeneous in definitions and outcomes, precluding meta‑analysis. Conclusions: Timely transition to fortified enteral nutrition with judicious mineral/vitamin D supplementation is central to OOP prevention. Standardized definitions, multicenter protocols, and longitudinal follow‑up are needed to clarify long‑term skeletal benefits.