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Shimonty A, Pin F, Prideaux M, Peng G, Huot J, Kim H, Rosen CJ, Spiegelman BM, Bonewald LF. Deletion of FNDC5/irisin modifies murine osteocyte function in a sex-specific manner. eLife 2024; 12:RP92263. [PMID: 38661340 PMCID: PMC11045224 DOI: 10.7554/elife.92263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Irisin, released from exercised muscle, has been shown to have beneficial effects on numerous tissues but its effects on bone are unclear. We found significant sex and genotype differences in bone from wildtype (WT) mice compared to mice lacking Fndc5 (knockout [KO]), with and without calcium deficiency. Despite their bone being indistinguishable from WT females, KO female mice were partially protected from osteocytic osteolysis and osteoclastic bone resorption when allowed to lactate or when placed on a low-calcium diet. Male KO mice have more but weaker bone compared to WT males, and when challenged with a low-calcium diet lost more bone than WT males. To begin to understand responsible molecular mechanisms, osteocyte transcriptomics was performed. Osteocytes from WT females had greater expression of genes associated with osteocytic osteolysis and osteoclastic bone resorption compared to WT males which had greater expression of genes associated with steroid and fatty acid metabolism. Few differences were observed between female KO and WT osteocytes, but with a low-calcium diet, the KO females had lower expression of genes responsible for osteocytic osteolysis and osteoclastic resorption than the WT females. Male KO osteocytes had lower expression of genes associated with steroid and fatty acid metabolism, but higher expression of genes associated with bone resorption compared to male WT. In conclusion, irisin plays a critical role in the development of the male but not the female skeleton and protects male but not female bone from calcium deficiency. We propose irisin ensures the survival of offspring by targeting the osteocyte to provide calcium in lactating females, a novel function for this myokine.
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Affiliation(s)
| | | | | | - Gang Peng
- Indiana UniversityIndianapolisUnited States
| | | | - Hyeonwoo Kim
- Korea Advanced Institute of Science and TechnologyDaejonRepublic of Korea
| | | | | | - Lynda F Bonewald
- Indiana UniversityIndianapolisUnited States
- Indiana Center for Musculoskeletal HealthIndianapolisUnited States
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Shimonty A, Pin F, Prideaux M, Peng G, Huot JR, Kim H, Rosen CJ, Spiegelman BM, Bonewald LF. Deletion of FNDC5/Irisin modifies murine osteocyte function in a sex-specific manner. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.11.06.565774. [PMID: 37986762 PMCID: PMC10659274 DOI: 10.1101/2023.11.06.565774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Irisin, released from exercised muscle, has been shown to have beneficial effects on numerous tissues but its effects on bone are unclear. We found significant sex and genotype differences in bone from wildtype (WT) mice compared to mice lacking Fndc5 (KO), with and without calcium deficiency. Despite their bone being indistinguishable from WT females, KO female mice were partially protected from osteocytic osteolysis and osteoclastic bone resorption when allowed to lactate or when placed on a low-calcium diet. Male KO mice have more but weaker bone compared to WT males, and when challenged with a low-calcium diet lost more bone than WT males. To begin to understand responsible molecular mechanisms, osteocyte transcriptomics was performed. Osteocytes from WT females had greater expression of genes associated with osteocytic osteolysis and osteoclastic bone resorption compared to WT males which had greater expression of genes associated with steroid and fatty acid metabolism. Few differences were observed between female KO and WT osteocytes, but with a low calcium diet, the KO females had lower expression of genes responsible for osteocytic osteolysis and osteoclastic resorption than the WT females. Male KO osteocytes had lower expression of genes associated with steroid and fatty acid metabolism, but higher expression of genes associated with bone resorption compared to male WT. In conclusion, irisin plays a critical role in the development of the male but not the female skeleton and protects male but not female bone from calcium deficiency. We propose irisin ensures the survival of offspring by targeting the osteocyte to provide calcium in lactating females, a novel function for this myokine.
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Affiliation(s)
- Anika Shimonty
- Indiana Center for Musculoskeletal Health, School of Medicine, Indiana University, IN, 46202, Indianapolis
| | - Fabrizio Pin
- Indiana Center for Musculoskeletal Health, Department of Anatomy, School of Medicine, Indiana University, IN, 46202, Indianapolis
| | - Matt Prideaux
- Indiana Center for Musculoskeletal Health, Department of Anatomy, School of Medicine, Indiana University, IN, 46202, Indianapolis
| | - Gang Peng
- Indiana Center for Musculoskeletal Health, Department of Medicine and Molecular Genetics, School of Medicine, Indiana University, IN, 46202, Indianapolis
| | - Joshua R Huot
- Indiana Center for Musculoskeletal Health, Department of Anatomy, School of Medicine, Indiana University, IN, 46202, Indianapolis
| | - Hyeonwoo Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Clifford J Rosen
- Maine Medical Center Research Institute, ME, 04074, Scarborough, USA
| | - Bruce M Spiegelman
- Department of Cancer Biology, Dana Farber Cancer Institute and Department of Cell Biology, Harvard University Medical School, MA, 02115, Boston, USA
| | - Lynda F Bonewald
- Department of Anatomy, Cell Biology and Physiology, Orthopaedic Surgery, School of Medicine, Indiana Center for Musculoskeletal Health, Indiana Center for Musculoskeletal Health, Indiana University, IN, 46202, Indianapolis
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Condon SB, Veitch M. The Experience of Pregnancy Associated Osteoporosis: An International Survey with Implications for Midwifery Care. Midwifery 2022; 115:103468. [DOI: 10.1016/j.midw.2022.103468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 08/06/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022]
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Madimenos FC, Liebert MA, Cepon‐Robins TJ, Urlacher SS, Josh Snodgrass J, Sugiyama LS, Stieglitz J. Disparities in bone density across contemporary Amazonian forager‐horticulturalists: Cross‐population comparison of the Tsimane and Shuar. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 171:50-64. [DOI: 10.1002/ajpa.23949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/26/2019] [Accepted: 10/07/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Felicia C. Madimenos
- Department of Anthropology Queens College (CUNY) Flushing New York
- New York Consortium on Evolutionary Primatology (NYCEP) New York New York
| | - Melissa A. Liebert
- Department of Anthropology Northern Arizona University Flagstaff Arizona
| | | | | | | | - Lawrence S. Sugiyama
- Department of Anthropology University of Oregon Eugene
- Institute of Cognitive and Decision Sciences University of Oregon Eugene Oregon
| | - Jonathan Stieglitz
- Université Toulouse 1 Capitole Toulouse France
- Institute for Advanced Study in Toulouse Toulouse France
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Coşgunarslan A, Canger EM, Soydan Çabuk D, Kış HC. The evaluation of the mandibular bone structure changes related to lactation with fractal analysis. Oral Radiol 2019; 36:238-247. [DOI: 10.1007/s11282-019-00400-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022]
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Gonçalves ACS, Ferreira MDF, Hasselmann MH, Faerstein E. O efeito da amamentação na massa óssea de mulheres na pós-menopausa: revisão sistemática de estudos observacionais. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2015. [DOI: 10.1590/s1519-38292015000300002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objetivos:avaliar o efeito da amamentação na massa óssea de mulheres na pós-menopausa.Métodos:trata-se de revisão sistemática de estudos observacionais. A pesquisa da literatura foi realizada nas bases de dados bibliográficos Lilacs, Medline e Scopus, em junho de 2015, sem restrição quanto ao ano de publicação. Para ser incluído nesta revisão, o artigo deveria avaliar o histórico de amamentação e a massa óssea na pós-menopausa, sendo suas referências checadas para busca de novos estudos. Dois revisores, de forma independente, realizaram a extração de dados e a avaliação da suscetibilidade a vieses dos estudos.Resultados:foram selecionados 34 estudos, dos quais seis (26,5%) mostraram que a prática de amamentação aumentou significativamente a massa óssea e 15 (44%) encontraram o inverso. Constatou-se grande diversidade entre os estudos quanto à população de estudo, mensuração da exposição e sítios de avaliação da massa óssea, dificultando a comparabilidade entre os resultados.Conclusões:a marcante heterogeneidade dos estudos torna inconclusiva a direção da associação entre a amamentação e a massa óssea em mulheres na pós-menopausa, sendo necessários estudos com maior rigor metodológico para avaliar esse problema de grande relevância para as áreas clínica e de saúde pública.
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McCormick NH, King J, Krebs N, Soybel DI, Kelleher SL. Redistribution of tissue zinc pools during lactation and dyshomeostasis during marginal zinc deficiency in mice. J Trace Elem Med Biol 2015; 29:170-5. [PMID: 24974135 PMCID: PMC4258524 DOI: 10.1016/j.jtemb.2014.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 11/28/2022]
Abstract
Zinc (Zn) requirements are increased during lactation. Increased demand is partially met through increased Zn absorption from the diet. It is estimated that 60-80% of women of reproductive age are at risk for Zn deficiency due to low intake of bioavailable Zn and increased demands during pregnancy and lactation. How Zn is redistributed within the body to meet the demands of lactation, and how Zn deficiency affects this process, is not understood. Female C57bl/6J mice were fed a control (ZA; 30mg Zn/kg) or a marginally Zn deficient (ZD; 15mg Zn/kg) diet for 30 days prior to mating through mid-lactation and compared with nulliparous mice fed the same diets. While stomach and plasma Zn concentration increased during lactation in mice fed ZA, mice fed ZD had lower stomach Zn concentration and abrogated plasma Zn levels during lactation. Additionally, femur Zn decreased during lactation in mice fed ZA, while mice fed ZD did not experience this decrease. Furthermore, red blood cell, pancreas, muscle and mammary gland Zn concentration increased, and liver and adrenal gland Zn decreased during lactation, independent of diet, while kidney Zn concentration increased only in mice fed ZD. Finally, maternal Zn deficiency significantly increased the liver Zn concentration in offspring but decreased weight gain and survival. This study provides novel insight into how Zn is redistributed to meet the increased metabolic demands of lactation and how marginal Zn deficiency interferes with these homeostatic adjustments.
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Affiliation(s)
- Nicholas H McCormick
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Janet King
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA
| | - Nancy Krebs
- University of Colorado, School of Medicine, Aurora, CO 80045, USA
| | - David I Soybel
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA; Departments of Surgery and Cell and Molecular Physiology, Penn State Hershey College of Medicine, Hershey, PA 17033, USA
| | - Shannon L Kelleher
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA; Departments of Surgery and Cell and Molecular Physiology, Penn State Hershey College of Medicine, Hershey, PA 17033, USA.
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Diogenes MEL, Bezerra FF, Rezende EP, Taveira MF, Pinhal I, Donangelo CM. Effect of calcium plus vitamin D supplementation during pregnancy in Brazilian adolescent mothers: a randomized, placebo-controlled trial. Am J Clin Nutr 2013; 98:82-91. [PMID: 23719547 DOI: 10.3945/ajcn.112.056275] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pregnancy and lactation in adolescents with habitually low calcium intake may adversely affect maternal bone mass. OBJECTIVE We investigated the effect of calcium plus vitamin D supplementation during pregnancy on bone mass during lactation in Brazilian adolescent mothers with low-calcium diets (∼600 mg/d). DESIGN Pregnant adolescents (14-19 y) randomly received daily calcium (600 mg) plus vitamin D3 (200 IU) (n = 30) or a placebo (n = 26) from 26 wk of pregnancy (baseline) until parturition. The bone mineral content (BMC), bone area (BA), and bone mineral density (BMD) at the total body, lumbar spine, and hip (total and femoral neck) were evaluated by using dual-energy X-ray absorptiometry at 5 and 20 wk postpartum. Serum hormones and 25-hydroxyvitamin D [25(OH)D] were measured. Group comparisons were adjusted for significant covariates. RESULTS The mean serum 25(OH)D concentration was 59 nmol/L at baseline. In comparison with the placebo, 25(OH)D tended to be 14-15 nmol/L higher postpartum in the supplemented group (P = 0.08). Total body and hip BMC and BMD decreased over time (P ≤ 0.005) in both groups with a group × time interaction at the femoral neck (P < 0.04). Supplemented mothers had higher lumbar spine BA (6.7%; P = 0.002) and lumbar spine BMC (7.9%, P = 0.08) than did mothers who consumed the placebo at 5 wk postpartum. At 20 wk postpartum, differences between groups were more evident, with higher lumbar spine BMC (13.9%), lumbar spine BA (6.2%), and lumbar spine BMD (10.6%) in the supplemented group (P ≤ 0.008). CONCLUSIONS Calcium plus vitamin D supplementation during pregnancy of adolescents with low calcium intake results in higher lumbar spine bone mass and a reduced rate of femoral neck bone loss during lactation. Additional studies are required to determine whether bone effects are temporary or long-lasting. This trial was registered at clinicaltrials.gov as NCT01732328.
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Affiliation(s)
- Maria Eduarda L Diogenes
- Laboratório de Bioquímica Nutricional e de Alimentos, Instituto de Química and the Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
Milk is successfully produced by mothers regardless of their nutritional status. Nevertheless, the concentrations of some nutrients, specifically vitamins A, D, B1, B2, B3, B6, and B12, fatty acids, and iodine, in human milk depend on or are influenced by maternal diet. A healthy and varied diet during lactation ensures adequate maternal nutrition and optimal concentration of some nutrients in human milk. Exclusive breastfeeding meets the nutritional needs of infants for 6 months of life with the exception of vitamins D and K, which should be given to breastfed infants as supplements.
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Affiliation(s)
- Christina J Valentine
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Donangelo CM, King JC. Maternal zinc intakes and homeostatic adjustments during pregnancy and lactation. Nutrients 2012; 4:782-98. [PMID: 22852063 PMCID: PMC3407994 DOI: 10.3390/nu4070782] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 07/12/2012] [Accepted: 07/13/2012] [Indexed: 12/12/2022] Open
Abstract
Zinc plays critical roles during embryogenesis, fetal growth, and milk secretion, which increase the zinc need for pregnancy and lactation. Increased needs can be met by increasing the dietary zinc intake, along with making homeostatic adjustments in zinc utilization. Potential homeostatic adjustments include changes in circulating zinc, increased zinc absorption, decreased zinc losses, and changes in whole body zinc kinetics. Although severe zinc deficiency during pregnancy has devastating effects, systematic reviews and meta-analysis of the effect of maternal zinc supplementation on pregnancy outcomes have consistently shown a limited benefit. We hypothesize, therefore, that zinc homeostatic adjustments during pregnancy and lactation improve zinc utilization sufficiently to provide the increased zinc needs in these stages and, therefore, mitigate immediate detrimental effects due to a low zinc intake. The specific questions addressed are the following: How is zinc utilization altered during pregnancy and lactation? Are those homeostatic adjustments influenced by maternal zinc status, dietary zinc, or zinc supplementation? These questions are addressed by critically reviewing results from published human studies on zinc homeostasis during pregnancy and lactation carried out in different populations worldwide.
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Affiliation(s)
| | - Janet C. King
- Children’s Hospital Oakland Research Institute, 5900 Martin Luther King Jr Way, Oakland, CA 94609, USA
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Byrd LM, Shiach CR, Hay CRM, Johnston TA. Osteopenic fractures in pregnancy: is low molecular weight heparin (LMWH) implicated? J OBSTET GYNAECOL 2009; 28:539-42. [PMID: 18850439 DOI: 10.1080/01443610802237080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- L M Byrd
- St Mary's Hospital, Manchester, UK.
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Peterson CA, Schnell JD, Kubas KL, Rottinghaus GE. Effects of soy isoflavone consumption on bone structure and milk mineral concentration in a rat model of lactation-associated bone loss. Eur J Nutr 2009; 48:84-91. [PMID: 19093161 DOI: 10.1007/s00394-008-0765-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 11/28/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Like menopause, during complete lactation, circulating estrogen concentrations are markedly reduced, resulting in amplified bone resorption. AIM OF STUDY To investigate the effects of soy isoflavones, common dietary components used to mitigate the bone loss of menopause, on the bone loss associated with lactation. METHODS Lactating rats were randomized to one of four diets supplemented with different levels of soy isoflavones (0, 2, 4, 8 mg aglycone isoflavone/g protein). Milk was collected from all dams between days 12 and 15 of lactation and was analyzed for calcium, phosphorus and genistein concentrations. Serum and bones from half of the animals from each diet group were taken at weaning and from the remaining half at 4 weeks post-weaning. Bones underwent histomorphometric analysis and serum was used for genistein determinations. RESULTS Serum genistein and milk concentrations reflected dietary isoflavone dose. Isoflavone intake had no effect on any of the bone changes associated with lactation or recovery. Milk calcium and mineral concentrations were unaffected by dietary isoflavones. CONCLUSIONS Consumption of soy isoflavones, in levels that can be readily attained through soy foods, have neither protective effects on bone nor deleterious effects on milk quality or quantity during lactation.
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Affiliation(s)
- Catherine A Peterson
- Dept. of Nutritional Sciences, University of Missouri, 217 Gwynn Hall, Columbia, MO 65211, USA.
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Guilbert ER, Brown JP, Kaunitz AM, Wagner MS, Bérubé J, Charbonneau L, Francoeur D, Gilbert A, Gilbert F, Roy G, Senikas V, Jacob R, Morin R. The use of depot-medroxyprogesterone acetate in contraception and its potential impact on skeletal health. Contraception 2009; 79:167-77. [PMID: 19185668 DOI: 10.1016/j.contraception.2008.10.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 10/08/2008] [Accepted: 10/09/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND In the fall of 2007, the controversy about the contraceptive use of depot-medroxyprogesterone acetate (DMPA) and its potential impact on skeletal health reached the media in the province of Quebec, Canada, thereby becoming a matter of concern for the lay public and physicians. In order to discuss this subject openly, the National Institute of Public Health of Quebec (INSPQ) organized a scientific meeting on February 15, 2008, with targeted physicians delegated by their medical associations in the fields of general practice, obstetrics and gynaecology, rheumatology, orthopaedic surgery, physiatry and endocrinology. STUDY DESIGN Participants reviewed the scientific literature using the study classification method according to the level of evidence, reviewed published guidelines of medical societies and organizations on the subject and reached a consensus position. This manuscript presents a review of the literature and describes the consensus position of the targeted medical associations. RESULTS The consensus position adopted by all the targeted medical associations determined that DMPA was a cost-effective contraceptive option that must be considered in the light of the clinical situation and preference of each woman. Candidates for injectable contraception should be informed that the use of DMPA is associated with a slight decrease in bone mineral density (BMD), which is largely, if not completely, reversible. There should not be an absolute limit to the length of time that the DMPA contraceptive is used, regardless of the woman's age. Monitoring BMD is not recommended among users of DMPA for contraceptive purposes. Finally, the consensus statement declared that, although supplements of calcium and vitamin D are beneficial for skeletal health for women in general, such supplementation should not be recommended solely based on a woman's use of DMPA. CONCLUSION Given the scientific evidences, DMPA use remains a valid contraceptive option for women. Its potential impact on BMD must be balanced against the significant individual, familial and social consequences of unintended pregnancy.
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Kaunitz AM, Arias R, McClung M. Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception 2008; 77:67-76. [PMID: 18226668 DOI: 10.1016/j.contraception.2007.10.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 10/15/2007] [Accepted: 10/16/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND While depot medroxyprogesterone acetate (DMPA) is a highly effective contraceptive used by millions of women, its use is associated with bone mineral density (BMD) loss, raising concerns about long-term risk of osteoporosis and/or fractures. STUDY DESIGN We conducted a systematic review of studies published in PubMed from 1996 to 2006, evaluating changes in BMD after discontinuation of DMPA. Ten primary clinical or observational studies were identified addressing this issue. RESULTS BMD consistently returned toward or to baseline values following DMPA discontinuation in women of all ages. This recovery in BMD was seen as early as 24 weeks after stopping therapy and persisted for as long as women were followed up; BMD in past DMPA users was similar to that in nonusers. CONCLUSIONS Bone loss occurring with DMPA use is reversible and is not likely to be an important risk factor for low bone density and fractures in older women, although data on fracture risk in DMPA users are lacking.
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Affiliation(s)
- Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
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Abstract
PURPOSE OF REVIEW To help clinicians guide adolescent patients to sound choices regarding long-acting contraceptives. The safety, side effects and non-contraceptive benefits of injectable, implantable and intrauterine contraception are detailed. RECENT FINDINGS The use of depot medroxyprogesterone acetate contraceptive injections has been associated with declines in teenage pregnancies in the United States. Although the US Food and Drug Administration has placed a black box warning concerning skeletal health and depot medroxyprogesterone acetate, data in adolescents confirm that declines in bone mineral density with depot medroxyprogesterone acetate are fully reversible. Concerns regarding skeletal health should not restrict the initiation or continuation of depot medroxyprogesterone acetate in adolescents. A highly effective, convenient, and easy to insert/remove single rod progestin-only contraceptive implant (Implanon) is now available in the United States. Although not widely used in adolescents, intrauterine devices offer selected adolescents convenient, highly effective, safe birth control. Use of the progestin-releasing intrauterine device (Mirena) is also associated with important non-contraceptive benefits. SUMMARY The efficacy and convenience associated with long-acting contraceptives make them indispensable for adolescent patients. This review will help clinicians guide teenage patients towards sound contraceptive choices and the successful long-term use of injectable, implantable and intrauterine methods of birth control.
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Affiliation(s)
- Lama L Tolaymat
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Florida 32207, USA.
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Silva HGV, Tórtora RP, Farias MLF. Increased bone turnover during the third trimester of pregnancy and decreased bone mineral density after parturition in adolescents as compared to age-matched control patients. Gynecol Endocrinol 2005; 21:174-9. [PMID: 16335911 DOI: 10.1080/09513590500279675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
To evaluate the impact of pregnancy on bone, we studied bone turnover at the first (T1) and third (T3) trimester of gestation in 58 adolescents and 28 healthy adolescents who had never been pregnant. Total body (TB) and lumbar spine (LS) bone mineral density (BMD) and body composition were evaluated by dual-energy X-ray absorptiometry in all control patients (C) and after parturition in 28 pregnant patients (G). Paired and unpaired t tests, Mann-Whitney and Pearson correlation tests were used. Bone turnover markers were above the reference range for adult women in more than 80% of the adolescents, with no difference between C and G patients at T1. Increase in urinary N-telopeptide crosslinks of type I collagen and serum bone-specific alkaline phosphatase, markers of bone turnover, was seen during pregnancy ( p < 0.0001). Body composition did not differ between groups, but LS BMD, percentage of expected LS BMD, LS Z-score, percentage of expected TB BMD and TB Z-score were lower in G than C patients ( p < 0.05). TB BMD was positively correlated with LS BMD (r2 = 0.52). The inverse correlations between bone markers and LS BMD suggest that the increased bone turnover during pregnancy probably explains the low bone density after parturition. The impact on future peak bone mass must be studied.
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Affiliation(s)
- Henyse G V Silva
- Division of Endocrinology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janiero, Brazil
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