Bone metabolism and osteoporosis during pregnancy and lactation

Lujano-Negrete, Abraham Yair; Rodríguez-Ruiz, Martha Cecilia; Skinner-Taylor, Cassandra Michele; Pérez-Barbosa, Lorena; Garza, Jesús Alberto Cárdenas‐de la; García-Hernández, Pedro Alberto; Espinosa-Banuelos, Luis Gerardo; Gutierrez-Leal, Luz Fernanda; Jezzini-Martínez, Sofia; Galarza‐Delgado, Dionicio Ángel

doi:10.1007/s11657-022-01077-x

Cited by 19 publications

(12 citation statements)

References 48 publications

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“…reproduction on bone elemental composition, as previously deposited bone likely contributes to meeting the elemental demands of the developing fetuses [42]. It is also possible that our records fail to report any unsuccessful pregnancy that M591 might have experienced before the first one reported at 7.8 years.…”

Section: Plos Onementioning

confidence: 85%

“…Work investigating the effects of parity on bone mineral content and density in rhesus macaques has also found that bone characteristics differ between age-matched parous and nulliparous females [ 41 ]. These combined findings indicate a retroactive effect of reproduction on bone elemental composition, as previously deposited bone likely contributes to meeting the elemental demands of the developing fetuses [ 42 ]. It is also possible that our records fail to report any unsuccessful pregnancy that M591 might have experienced before the first one reported at 7.8 years.…”

Section: Discussionmentioning

confidence: 99%

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Elemental composition of primary lamellar bone differs between parous and nulliparous rhesus macaque females

Cerrito

Goldstein

et al. 2022

PLoS ONE

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Extracting life history information from mineralized hard tissues of extant and extinct species is an ongoing challenge in evolutionary and conservation studies. Primary lamellar bone is a mineralized tissue with multidien periodicity that begins deposition prenatally and continues until adulthood albeit with concurrent resorption, thus maintaining a record spanning several years of an individual’s life. Here, we use field-emission scanning electron microscopy and energy-dispersive X-ray analysis to measure the relative concentrations of calcium, phosphorous, oxygen, magnesium and sodium in the femora of seven rhesus macaque with known medical and life-history information. We find that the concentration of these elements distinguishes parous from nulliparous females; that in females calcium and phosphorus are lower in bone formed during reproductive events; and that significant differences in relative magnesium concentration correlate with breastfeeding in infants.

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Section: Plos Onementioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Elemental composition of primary lamellar bone differs between parous and nulliparous rhesus macaque females

Cerrito

Goldstein

et al. 2022

PLoS ONE

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“…Some studies have shown that increased calcium requirement for fetal skeletal development may also contribute to the development of PLO. At the end of pregnancy, fetal bone formation consumes about 30 grams of calcium, and more than 80% of calcium deposition occurs in the last trimester, which causes a sharp loss of maternal calcium and might lead to PLO during this period [16,17]. In addition, low calcium intake, vitamin D de ciency, and use of glucocorticoids, heparin, and some anticonvulsants during pregnancy have also been suggested as risk factors for PLO [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy- and lactation-associated osteoporosis: A report of six cases

Qian¹,

Wang²,

Qu³

et al. 2023

Preprint

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Objective To illustrate the clinical characteristics of pregnancy- and lactation-associated osteoporosis (PLO) by retrospectively analyzing six cases of PLO. Methods Six cases of PLO diagnosed in our Endocrinology and Orthopedics Departments from January 2018 to June 2020 were retrospectively studied. The baseline characteristics, clinical features, laboratory findings, radiological manifestations and follow-up outcomes were analyzed and compared with previous reports. Results The mean age of the six patients was 33.5 years old (range 30-36 years) with a mean height of 163 cm (range 151-171 cm), mean weight of 56.2 kg (range 47-73 kg) and mean body mass index (BMI) of 21.3 kg/m2 (range 17.4-28.5 kg/m2). All enrolled patients complained of low back pain, with a mean visual analogue scale (VAS) score of 7.0 points (4-10). The mean bone mineral density (BMD), as assessed by the Z-score obtained from the dual-energy X-ray absorptiometry measurement, was -2.90 (range -4.37- -1.34). All six patients underwent magnetic resonance imaging (MRI) scans and vertebral compressive fractures were detected in four patients. The main feature of MRI images of the patients was the appearance of strip-shaped abnormal signal area under the upper endplate of the vertebrae, with low T1 phase signal and high T2 fat-suppressed phase signal. The fractures mainly affected the thoracolumbar regions. Fractures in four patients were all multiple vertebral fractures, with at least two and at most nine vertebral fractures. All six patients received conservative treatment, and no surgical intervention. After a mean follow-up of 27.3 months (range 24-31 months), the symptoms of the six patients were significantly relieved, although four patients still had low back pain to varying degrees. Conclusion PLO tends to occur in older and thinner women with clinical manifestations varying in severity. MRI often reveals multiple vertebral compressive fractures in patients with PLO. PLO has good prognosis with conservative treatment, but complete relief may take a long time.

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“…An individual decision should be taken extremely cautiously by a multidisciplinary team. The complete panel of potential complications that interfere with pregnancy outcome also includes endocrine components from DM for the adequate replacement of hypothyroidism and sufficient VD to maintain bone health [ 164 , 165 , 166 , 167 ]. Prior anti-OP medication has insufficient evidence, but this is not a contra-indication [ 165 , 166 , 167 ].…”

Section: Pregnancy Outcomementioning

confidence: 99%

“…The complete panel of potential complications that interfere with pregnancy outcome also includes endocrine components from DM for the adequate replacement of hypothyroidism and sufficient VD to maintain bone health [ 164 , 165 , 166 , 167 ]. Prior anti-OP medication has insufficient evidence, but this is not a contra-indication [ 165 , 166 , 167 ]. Mild EDs such as subclinical hypothyroidism or IFG/IGT might become overt or clinically symptomatic during pregnancy, which is why practitioners should be aware of these issues.…”

Section: Pregnancy Outcomementioning

confidence: 99%

New Entity—Thalassemic Endocrine Disease: Major Beta-Thalassemia and Endocrine Involvement

et al. 2022

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Beta-thalassemia (BTH), a recessively inherited haemoglobin (Hb) disorder, causes iron overload (IO), extra-medullary haematopoiesis and bone marrow expansion with major clinical impact. The main objective of this review is to address endocrine components (including aspects of reproductive health as fertility potential and pregnancy outcome) in major beta-thalassemia patients, a complex panel known as thalassemic endocrine disease (TED). We included English, full-text articles based on PubMed research (January 2017–June 2022). TED includes hypogonadism (hypoGn), anomalies of GH/IGF1 axes with growth retardation, hypothyroidism (hypoT), hypoparathyroidism (hypoPT), glucose profile anomalies, adrenal insufficiency, reduced bone mineral density (BMD), and deterioration of microarchitecture with increased fracture risk (FR). The prevalence of each ED varies with population, criteria of definition, etc. At least one out of every three to four children below the age of 12 y have one ED. ED correlates with ferritin and poor compliance to therapy, but not all studies agree. Up to 86% of the adult population is affected by an ED. Age is a positive linear predictor for ED. Low IGF1 is found in 95% of the population with GH deficiency (GHD), but also in 93.6% of persons without GHD. HypoT is mostly pituitary-related; it is not clinically manifested in the majority of cases, hence the importance of TSH/FT4 screening. HypoT is found at any age, with the prevalence varying between 8.3% and 30%. Non-compliance to chelation increases the risk of hypoT, yet not all studies confirmed the correlation with chelation history (reversible hypoT under chelation is reported). The pitfalls of TSH interpretation due to hypophyseal IO should be taken into consideration. HypoPT prevalence varies from 6.66% (below the age of 12) to a maximum of 40% (depending on the study). Serum ferritin might act as a stimulator of FGF23. Associated hypocalcaemia transitions from asymptomatic to severe manifestations. HypoPT is mostly found in association with growth retardation and hypoGn. TED-associated adrenal dysfunction is typically mild; an index of suspicion should be considered due to potential life-threatening complications. Periodic check-up by ACTH stimulation test is advised. Adrenal insufficiency/hypocortisolism status is the rarest ED (but some reported a prevalence of up to one third of patients). Significantly, many studies did not routinely perform a dynamic test. Atypical EM sites might be found in adrenals, mimicking an incidentaloma. Between 7.5–10% of children with major BTH have DM; screening starts by the age of 10, and ferritin correlated with glycaemia. Larger studies found DM in up to 34%of cases. Many studies do not take into consideration IGF, IGT, or do not routinely include OGTT. Glucose anomalies are time dependent. Emerging new markers represent promising alternatives, such as insulin secretion-sensitivity index-2. The pitfalls of glucose profile interpretation include the levels of HbA1c and the particular risk of gestational DM. Thalassemia bone disease (TBD) is related to hypoGn-related osteoporosis, renal function anomalies, DM, GHD, malnutrition, chronic hypoxia-induced calcium malabsorption, and transplant-associated protocols. Low BMD was identified in both paediatric and adult population; the prevalence of osteoporosis/TBD in major BTH patients varies; the highest rate is 40–72% depending on age, studied parameters, DXA evaluation and corrections, and screening thoracic–lumbar spine X-ray. Lower TBS and abnormal dynamics of bone turnover markers are reported. The largest cohorts on transfusion-dependent BTH identified the prevalence of hypoGn to be between 44.5% and 82%. Ferritin positively correlates with pubertal delay, and negatively with pituitary volume. Some authors appreciate hypoGn as the most frequent ED below the age of 15. Long-term untreated hypoGn induces a high cardiovascular risk and increased FR. Hormonal replacement therapy is necessary in addition to specific BTH therapy. Infertility underlines TED-related hormonal elements (primary and secondary hypoGn) and IO-induced gonadal toxicity. Males with BTH are at risk of infertility due to germ cell loss. IO induces an excessive amount of free radicals which impair the quality of sperm, iron being a local catalyser of ROS. Adequate chelation might improve fertility issues. Due to the advances in current therapies, the reproductive health of females with major BTH is improving; a low level of statistical significance reflects the pregnancy status in major BTH (limited data on spontaneous pregnancies and growing evidence of the induction of ovulation/assisted reproductive techniques). Pregnancy outcome also depends on TED approach, including factors such as DM control, adequate replacement of hypoT and hypoPT, and vitamin D supplementation for bone health. Asymptomatic TED elements such as subclinical hypothyroidism or IFG/IGT might become overt during pregnancy. Endocrine glands are particularly sensitive to iron deposits, hence TED includes a complicated puzzle of EDs which massively impacts on the overall picture, including the quality of life in major BTH. The BTH prognostic has registered progress in the last decades due to modern therapy, but the medical and social burden remains elevated. Genetic counselling represents a major step in approaching TH individuals, including as part of the pre-conception assessment. A multidisciplinary surveillance team is mandatory.

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Bone metabolism and osteoporosis during pregnancy and lactation

Cited by 19 publications

References 48 publications

Elemental composition of primary lamellar bone differs between parous and nulliparous rhesus macaque females

Elemental composition of primary lamellar bone differs between parous and nulliparous rhesus macaque females

Pregnancy- and lactation-associated osteoporosis: A report of six cases

New Entity—Thalassemic Endocrine Disease: Major Beta-Thalassemia and Endocrine Involvement

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