Changes in bone density and metabolism in pregnancy

Wisser, Josef; Florio, I; Neff, M.; König, V.; Huch, R.; Huch, A.; Mandach, Ursula von

doi:10.1080/j.0001-6349.2005.00766.x

Cited by 16 publications

(20 citation statements)

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“…The usefulness of osteocalcin as an indicator of bone turnover during pregnancy, therefore, has been questioned (13) . However, lower concentrations have been reported in women classified as 'slow losers' on the basis of change in forearm trabecular vBMD during pregnancy, and the authors speculated that reduced osteocalcin concentrations may facilitate bone formation (43) .…”

Section: Maternal Bone Mineral Mobilisation: Bone Turnover Studiesmentioning

confidence: 99%

“…This may reflect the increase in plasma volume, as indicated by the fall in plasma albumin (39,150) . However, the concentration of ionised Ca, the tightly regulated fraction in the circulation, is unchanged between early and late pregnancy (43) and remains within the range found in NPNL women (150) .…”

Section: Regulation Of Calcium Metabolism In Pregnancy and Lactationmentioning

confidence: 99%

“…The one study using pQCT of the distal radius reported a significant decrease in vBMD between the first and last trimester of pregnancy in the trabecular region but not in the cortical region of the bone (43) . In one study that used QCT (67) , vBMD of the lumbar spine increased by 0·6 % (NS) between pre-pregnancy and shortly after delivery.…”

Section: Calcium Intake Absorption and Balancementioning

confidence: 99%

“…Longitudinal studies have demonstrated that the total plasma concentration of Ca (the sum of ionised and protein-bound fractions) decreases during pregnancy compared with before pregnancy or in early gestation (12,39,43,67) . This may reflect the increase in plasma volume, as indicated by the fall in plasma albumin (39,150) .…”

Section: Regulation Of Calcium Metabolism In Pregnancy and Lactationmentioning

confidence: 99%

“…Although the dose of radiation is low, whole-body and axial skeletal sites of pregnant women generally are not scanned using DXA, DPA or QCT for research purposes, in order to minimise unnecessary exposure of the fetus and because the results cannot distinguish between maternal and fetal tissues. Peripheral X-ray techniques in which the fetus is not exposed to additional radiation, such as forearm absorptiometry (39 -42) and pQCT (43) , are used for studies in pregnant women.…”

Section: Measures Of Bone Mineral Content Density and Sizementioning

confidence: 99%

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Calcium economy in human pregnancy and lactation

et al. 2012

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Pregnancy and lactation are times of additional demand for Ca. Ca is transferred across the placenta for fetal skeletal mineralisation, and supplied to the mammary gland for secretion into breast milk. In theory, these additional maternal requirements could be met through mobilisation of Ca from the skeleton, increased intestinal Ca absorption efficiency, enhanced renal Ca retention or greater dietary Ca intake. The extent to which any or all of these apply, the underpinning biological mechanisms and the possible consequences for maternal and infant bone health in the short and long term are the focus of the present review. The complexities in the methodological aspects of interpreting the literature in this area are highlighted and the inter-individual variation in the response to pregnancy and lactation is reviewed. In summary, human pregnancy and lactation are associated with changes in Ca and bone metabolism that support the transfer of Ca between mother and child. The changes generally appear to be independent of maternal Ca supply in populations where Ca intakes are close to current recommendations. Evidence suggests that the processes are physiological in humans and that they provide sufficient Ca for fetal growth and breast-milk production, without relying on an increase in dietary Ca intake or compromising long-term maternal bone health. Further research is needed to determine the limitations of the maternal response to the Ca demands of pregnancy and lactation, especially among mothers with marginal and low dietary Ca intake, and to define vitamin D adequacy for reproductive women.

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Section: Maternal Bone Mineral Mobilisation: Bone Turnover Studiesmentioning

confidence: 99%

Section: Regulation Of Calcium Metabolism In Pregnancy and Lactationmentioning

confidence: 99%

Section: Calcium Intake Absorption and Balancementioning

confidence: 99%

Section: Regulation Of Calcium Metabolism In Pregnancy and Lactationmentioning

confidence: 99%

Section: Measures Of Bone Mineral Content Density and Sizementioning

confidence: 99%

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Calcium economy in human pregnancy and lactation

et al. 2012

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Pregnancy-Related Change in pQCT and Bone Biochemistry in a Population With a Habitually Low Calcium Intake

Breasail

Ward

Schoenbuchner

et al. 2020

Journal of Bone and Mineral Research

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In pregnancy, changes in maternal calcium (Ca) economy occur to satisfy fetal Ca demand. It is unclear whether maternal mineral reserves facilitate these requirements and no data exist from sub-Saharan Africa. The aim was to determine skeletal changes with peripheral quantitative computed tomography (pQCT) and bone biochemistry between early second and third trimesters. Pregnant rural Gambians aged 18 to 45 years (n = 467) participating in a trial of antenatal nutritional supplements (ISRCTN49285450) had pQCT scans and blood collections at mean (SD) 14 (3) and 31 (1) weeks' gestation. Outcomes were pQCT: radius/tibia 4% total volumetric bone mineral density (vBMD), trabecular vBMD, total cross-sectional area (CSA), 33%/38% radius/tibia cortical vBMD, bone mineral content (BMC), total CSA; biochemistry: collagen type 1 cross-linked β-C-telopeptide (β-CTX), type 1 procollagen N-terminal (P1NP), parathyroid hormone (PTH), and 1,25(OH) 2 D. Independent t tests tested whether pooled or within-group changes differed from 0. Multiple regression was performed adjusting for age. Data for change are expressed as mean (confidence interval [CI] 2.5, 97.5%). Radius trabecular vBMD, cortical vBMD, and BMC increased by 1.15 (0.55, 1.75)%, 0.41 (0.24, 0.58)%, and 0.47 (0.25, 0.69)%. Tibia total and trabecular vBMD increased by 0.34 (0.15, 0.54)% and 0.46 (0.17, 0.74)%, while tibia cortical vBMD, BMC, and cortical CSA increased by 0.35 (0.26, 0.44)%, 0.55 (0.41, 0.68)% and 0.20 (0.09, 0.31)%, respectively. CTX, PTH, and 1,25(OH) 2 D increased by 23.0 (15.09, 29.29)%, 13.2 (8.44, 19.34)%, and 21.0 (17.67, 24.29)%, while P1NP decreased by 32.4 (−37.19, −28.17)%. No evidence of mobilization was observed in the peripheral skeleton. Resorption, although higher in late versus early gestation, was lower throughout pregnancy compared with non-pregnant non-lactating (NPNL) in the same community. Formation was lower in late pregnancy than in early, and below NPNL levels. This suggests a shift in the ratio of resorption to formation. Despite some evidence of change in bone metabolism, in this population, with habitually low Ca intakes, the peripheral skeleton was not mobilized as a Ca source for the fetus.

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Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report

Bonacker

Kröber

2013

Arch Orthop Trauma Surg

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Pregnancy-associated osteoporosis is a rare condition, which imposes multiple symptoms in the musculoskeletal system. Common complaints announced by patients are severe pain in the lower back, hips and the joints of the lower extremities with a reduced and less mobility status in general. Most of the patients' problems occur in the last trimester of pregnancy or postpartum and are often not diagnosed as side effects of osteoporosis but as problems associated with pregnancy. Although vertebral fractures are rare complications of pregnancy-associated osteoporosis, they should be always considered in women presenting with an acute pain syndrome in peripregnancy period. This case presents a 40-year-old primagravid woman who developed pain in hips and severe pain in the lower back causing an immobilization diagnosed with a pregnancy-associated osteoporosis with eight compression fractures in the thoracic and lumbar spine. Because of sagittal imbalance of the spine, she was treated with kyphoplasty at the four lumbar fractures and with bracing for the upper, thoracic ones, additional to the conservative anti-osteoporotic therapy. The authors discuss pregnancy-associated osteoporosis and its clinical presentation, as well as the indications of kyphoplasty, spinal alignment and the risk of single conservative treatment.

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Changes in bone density and metabolism in pregnancy

Cited by 16 publications

References 0 publications

Calcium economy in human pregnancy and lactation

Calcium economy in human pregnancy and lactation

Pregnancy-Related Change in pQCT and Bone Biochemistry in a Population With a Habitually Low Calcium Intake

Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report

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