The puzzle of lactational bone physiology: osteocytes masquerade as osteoclasts and osteoblasts

Ryan, Brittany A.; Kovacs, Christopher S.

doi:10.1172/jci130640

Cited by 14 publications

(11 citation statements)

References 23 publications

(22 reference statements)

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“…Dairy cows that experience a transient hypocalcemia in the immediate period post‐partum have been shown to produce more milk, suggesting an improved adaptation to lactation facilitated by transient hypocalcemia (McArt & Neves, 2020). Decreases in calcium concentrations during lactation are believed to trigger PTHrP production in the mammary gland, allowing PTHrP to potentiate bone calcium mobilization to liberate calcium for maternal and mammary pools (Ryan & Kovacs, 2019). Although PTH is a crucial calciotropic hormone, mammary‐derived PTHrP is believed to play a more dominant role in calcium homeostasis during lactation (Kovacs, 2005).…”

Section: Discussionmentioning

confidence: 99%

Elevated serotonin coordinates mammary metabolism in dairy cows

et al. 2021

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The onset of lactation requires a variety of physiological adaptions as a mammal transitions from a non-lactating to lactating state. In order to initiate lactation, a coordination of changes in tissue metabolism occurs in response to the physiological demands of lactation. Due to these immense nutrient demands by the mammary gland, many maternal adaptations occur to support lactation (Bauman & Currie, 1980). To meet these demands, in addition to traditionally

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Section: Discussionmentioning

confidence: 99%

Elevated serotonin coordinates mammary metabolism in dairy cows

et al. 2021

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“…The pathophysiology of PLO remains unclear. However, several risk factors have been described, such as low peak bone mass; genetic factors, namely inactivating mutations in low-density lipoprotein receptor-related protein 5 ( LRP5 ); impaired calcium absorption; inadequate calcium intake; vitamin D insufficiency; inadequate high release of parathyroid hormone–related peptide; diverse other conditions such as anorexia, oligomenorrhea, or relative estradiol deficiency; premature ovarian failure; low BMI; smoking; hypercalciuria; bed rest; and pharmacotherapy that may induce bone loss such as heparin, oral glucocorticoids, hypothalamic gonadotropin-releasing hormone analogues, and anticonvulsants [ 40 ]. In our study, major risk factors were present in 2 patients: One had a history of hyperprolactinemia and kidney stones with hypercalciuria, and the other had received very high doses of glucocorticoids during pregnancy for severe thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Severe Bone Microarchitecture Impairment in Women With Pregnancy and Lactation-Associated Osteoporosis

Scioscia

Vidal²,

Sarli

et al. 2021

Journal of the Endocrine Society

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Context Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition characterized by fragility fractures, mostly vertebral, during the third trimester of pregnancy or the early postpartum. Objective The aim of this study was to evaluate bone microarchitecture in women with PLO in order to better understand the pathophysiology of this disease. Design and methods In this retrospective study, we included women with PLO referred to our bone center between November 2007 and July 2012. We assessed bone mineral density (BMD) by DXA, bone turnover markers and bone microarchitecture by HR-pQCT. Results were compared with a control group of healthy lactating women. Results Among the seven primiparous patients with PLO, six suffered vertebral fractures and one developed a hip fracture during the seventh month of gestation. Fractures occurred within the eighth month of pregnancy and the fourth month of postpartum; vertebral fractures were multiple in 85.7%. Major or minor risk factors for osteoporosis were present in 86% of our patients. Trabecular density, number and thickness were 34%, 20% and 22% lower than controls, (p < 0.01, p = 0.01 and p = 0.01, respectively). Cortical parameters were also deteriorated but to a lesser extent. Conclusion In comparison with healthy lactating women, patients with PLO presented severe deterioration of bone trabecular and cortical microarchitecture. This significant compromise may explain the occurrence of multiple fractures in these otherwise healthy young women. Further prospective studies are needed in order to determine whether bone microarchitecture might be able to be restored in the future.

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“…Changes in bone and mineral metabolism during pregnancy and lactation occur to ensure an adequate mineral supply to meet the growing needs of the fetal skeleton and the newborns while preserving maternal health (Fig. 5) (4,5,8,156,157,158). During pregnancy, the plasma volume expansion with subsequently reduced albumin levels causes a decrease in total calcium concentrations.…”

Section: Parathyroid Disorders During Preconception Pregnancy and Lac...mentioning

confidence: 99%

“…Despite this mineral supply, pregnancy itself usually does not alter maternal BMD if the maternal calcium intake is adequate or result in only a modest 1-4% decrease in BMD (158). During lactation, mineral supply to breast milk mainly derives from the maternal skeleton that is exposed to increased bone resorption and osteocytic osteolysis (156). This translates into a significant decrease of about 5-10% in lumbar spine BMD after 6 months of exclusively nursing a singleton, with about half of this effect at the hip and radius (156,160).…”

Section: Parathyroid Disorders During Preconception Pregnancy and Lac...mentioning

confidence: 99%

“…During lactation, mineral supply to breast milk mainly derives from the maternal skeleton that is exposed to increased bone resorption and osteocytic osteolysis (156). This translates into a significant decrease of about 5-10% in lumbar spine BMD after 6 months of exclusively nursing a singleton, with about half of this effect at the hip and radius (156,160). Six to 12 months after weaning, the maternal BMD reaches its pre-pregnancy values or may even exceed them (156).…”

Section: Parathyroid Disorders During Preconception Pregnancy and Lac...mentioning

confidence: 99%

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European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)

Bollerslev

Rejnmark

Zahn

et al. 2022

European Journal of Endocrinology

122

125

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This European expert consensus statement provides recommendations for the diagnosis and management of primary hyperparathyroidism (PHPT), chronic hypoparathyroidism in adults (HypoPT), and parathyroid disorders in relation to pregnancy and lactation. Specified areas of interest and unmet needs identified by experts at the second ESE Educational Program of Parathyroid Disorders (PARAT) in 2019, were discussed during two virtual workshops in 2021, and subsequently developed by working groups with interest in the specified areas. PHPT is a common endocrine disease. However, its differential diagnosing to familial hypocalciuric hypercalcemia (FHH), the definition and clinical course of normocalcemic PHPT, and the optimal management of its recurrence after surgery represent areas of uncertainty requiring clarifications. HypoPT is an orphan disease characterized by low calcium concentrations due to insufficient PTH secretion, most often secondary to neck surgery. Prevention and prediction of surgical injury to the parathyroid glands are essential to limit the disease-related burden. Long-term treatment modalities including the place for PTH replacement therapy and the optimal biochemical monitoring and imaging surveillance for complications to treatment in chronic HypoPT, need to be refined. The physiological changes in calcium metabolism occurring during pregnancy and lactation modify the clinical presentation and management of parathyroid disorders in these periods of life. Modern interdisciplinary approaches to PHPT and HypoPT in pregnant and lactating women and their newborns children are proposed. The recommendations on clinical management presented here will serve as background for further educational material aimed for a broader clinical audience, and were developed with focus on endocrinologists in training.

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The puzzle of lactational bone physiology: osteocytes masquerade as osteoclasts and osteoblasts

Cited by 14 publications

References 23 publications

Elevated serotonin coordinates mammary metabolism in dairy cows

Elevated serotonin coordinates mammary metabolism in dairy cows

Severe Bone Microarchitecture Impairment in Women With Pregnancy and Lactation-Associated Osteoporosis

European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)

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