Lactation and Bone Turnover: A Conundrum of Marked Bone Loss in the Setting of Coupled Bone Turnover

Carneiro, R C G; Prebehalla, Linda; Tedesco, Mary Beth; Sereika, Susan M.; Hugo, Maryann; Hollis, Bruce W.; Gundberg, Caren M.; Stewart, Andrew F.; Horwitz, Mara J.

doi:10.1210/jc.2009-1518

Cited by 58 publications

(32 citation statements)

References 30 publications

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“…The increase in tubular reabsorption of calcium is attributable to PTHrP. Fractional excretion of calcium did not appear to be reduced in two recent cross-sectional studies from the same authors; however, the results were confounded by the lactating women consuming 60 and 80% more calcium than the unrelated controls (156,157).…”

Section: Human Datamentioning

confidence: 83%

“…B) HUMAN DATA. Free and total calcitriol falls to normal during postpartum (206,439,578,746,809,987) and remains normal throughout lactation and postweaning (156,157,206,207,348,385,470,505,632,764,805,871,987). One study found that extended lactation (Ͼ6 mo) was associated with higher calcitriol (348), another report found that calcitriol increased during the postweaning interval of bone recovery (871), and a third report found that calcitriol was 10% higher during lactation and that this persisted during the post-weaning interval (454).…”

Section: Calcitriolmentioning

confidence: 99%

“…Estradiol is suppressed to menopausal levels during early lactation (157,409,505,695,764), especially when basal levels of prolactin are elevated (409,695). Low estradiol may persist throughout lactation or recover to normal values after several months.…”

Section: Sex Steroids and Other Hormonesmentioning

confidence: 99%

“…Multiple studies have calculated a significant increase in tubular maximum for phosphate (18,156,157,206,324,468,470,558), which suggests that the kidneys are actively conserving phosphorus despite the phosphaturic actions of PTHrP and overt phosphaturia. This may imply the presence of an anti-phosphaturic factor during lactation or low levels of FGF23.…”

Section: Human Datamentioning

confidence: 99%

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Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

383

524

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During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ϳ30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

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Section: Human Datamentioning

confidence: 83%

Section: Calcitriolmentioning

confidence: 99%

Section: Sex Steroids and Other Hormonesmentioning

confidence: 99%

Section: Human Datamentioning

confidence: 99%

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Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

383

524

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“…However, premature infants accrue only half this amount. Demineralization of maternal trabecular skeleton supplies the calcium mediated by PTHrP (27). The neonate is more reliant on serum PTH and 1,25(OH) 2 D levels than the fetus and PTHrP is less important for mineral homeostasis.…”

Section: Infancymentioning

confidence: 99%

2. Vitamin D in Skeletal Growth and Development

Weaver¹,

Lewis²,

Laing³

2011

Translational Endocrinology &Amp; Metabolism: Vitamin D Update

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Vitamin D and calcium are important nutrients in skeletal growth and development. Absorption of calcium, the largest mineral constituent of bone, and the process of bone modeling, which builds and shapes bone during growth, are facilitated by vitamin D-dependent proteins. Thus, deficiency of vitamin D during growth can manifest as skeletal disorders. Rickets in infancy is the classic example. However, calcium can also be absorbed by a vitamin D-independent route, so that sufficient dietary calcium can often overcome vitamin D inadequacy with respect to the skeleton. Furthermore, rickets can occur because of calcium deficiency in the presence of adequate vitamin D status. The interdependence of calcium and vitamin D, and the opportunity to have a sufficient vitamin D supply from cutaneous production without depending on diet, make it difficult to set dietary vitamin D recommendations. The paucity of research studies on vitamin D status during growth has impeded our understanding of the skeletal effects of vitamin D. Moreover, there is increasing interest in the hypothesis that postnatal skeletal growth is influenced by in utero vitamin D status. This chapter evaluates the evidence for vitamin D's role in skeletal health during pregnancy, lactation, childhood, and adolescence. Case 2-1: RicketsA 10-month-old white female presented to the outpatient clinic with mild weight loss, pale skin, and lethargy. The latitude of the area is 43°N and the clinic visit took place in late March. When the patient's parents were queried about concerns, they revealed that the infant recently had a decrease in appetite. The infant's dietary history indicated that breast milk had been her primary source of nutrition to date, along with complementary foods, such as pureed rice, fruits, and vegetables. Infant drops containing 400 international units (IU) of vitamin D had been prescribed at birth, although compliance was poor, and the parents indicated that the infant had not received supplemental vita-

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Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness

Hollis

Johnson

Hulsey

et al. 2011

Journal of Bone and Mineral Research

705

774

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Background The need, safety and effectiveness of vitamin D supplementation during pregnancy remain controversial. Design In this randomized controlled trial, women with a singleton pregnancy at 12–16 weeks’ gestation received 400, 2000 or 4000 IU vitamin D3/day until delivery. The primary outcome was maternal/neonatal circulating 25(OH)D at delivery, with secondary outcomes 25(OH)D ≥80 nmol/L achieved and 25(OH)D concentration required to achieve maximal 1,25(OH)2D production. Results Of the 494 women enrolled, 350 women continued until delivery: Mean 25(OH)D by group at delivery and 1-month before delivery were significantly different (p<0.0001), and percent who achieved sufficiency was significantly different by group, greatest in 4000 IU group (p<0.0001). The relative risk (RR) for achieving ≥80 nmol/L within one month of delivery was significantly different between 2000 vs. 400 IU (RR 1.52 [CI 1.24–1.86]); 4000 vs. 400 (RR 1.60 [CI 1.32–1.95]), but not between 4000 vs. 2000 (RR 1.06 [CI 0.93–1.19]). Circulating 25(OH)D had a direct influence on circulating 1,25(OH)2D concentrations throughout pregnancy (p<0.0001) with maximal production of 1,25(OH)2D in all strata in the 4000 IU group. There were no differences between groups on any safety measure. Not a single adverse event was attributed to vitamin D supplementation or circulating 25(OH)D levels. Conclusions Vitamin D supplementation of 4,000 IU/day for pregnant women was safe and most effective in achieving sufficiency in all women and their neonates regardless of race while the current estimated average requirement was comparatively ineffective at achieving adequate circulating 25(OH)D, especially in African Americans.

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Lactation and Bone Turnover: A Conundrum of Marked Bone Loss in the Setting of Coupled Bone Turnover

Cited by 58 publications

References 30 publications

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

2. Vitamin D in Skeletal Growth and Development

Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness

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