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Fuggle NR, Reginster JY, Al-Daghri N, Bruyere O, Burlet N, Campusano C, Cooper C, Perez AD, Halbout P, Ghi T, Kaufman JM, Kurt A, Matijevic R, Radermecker RP, Tuzun S, Veronese N, Rizzoli R, Harvey NC, Brandi ML, Brandi ML. Radiofrequency echographic multi spectrometry (REMS) in the diagnosis and management of osteoporosis: state of the art. Aging Clin Exp Res 2024; 36:135. [PMID: 38904870 PMCID: PMC11192661 DOI: 10.1007/s40520-024-02784-w] [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] [Received: 02/23/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024]
Abstract
Radiofrequency Echographic Multi Spectrometry (REMS) is a radiation-free, portable technology, which can be used for the assessment and monitoring of osteoporosis at the lumbar spine and femoral neck and may facilitate wider access to axial BMD measurement compared with standard dual-energy x-ray absorptiometry (DXA).There is a growing literature demonstrating a strong correlation between DXA and REMS measures of BMD and further work supporting 5-year prediction of fracture using the REMS Fragility Score, which provides a measure of bone quality (in addition to the quantitative measure of BMD).The non-ionising radiation emitted by REMS allows it to be used in previously underserved populations including pregnant women and children and may facilitate more frequent measurement of BMD.The portability of the device means that it can be deployed to measure BMD for frail patients at the bedside (avoiding the complications in transfer and positioning which can occur with DXA), in primary care, the emergency department, low-resource settings and even at home.The current evidence base supports the technology as a useful tool in the management of osteoporosis as an alternative to DXA.
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Affiliation(s)
- Nicholas R Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Jean-Yves Reginster
- The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), Liege, Belgium
- Protein Research Chair, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Olivier Bruyere
- Faculty of Medicine, Department of Public Health Sciences, Research Unit in Public Health, Epidemiology and Health Economics (URSAPES), University of Liège, Liege, Belgium
| | - Nansa Burlet
- The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), Liege, Belgium
| | - Claudia Campusano
- Faculty of Medicine, Clinica Universidad de los Andes, Universidad de los Andes, Santiago, Chile
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Adolfo Diez Perez
- Department of Internal Medicine, Hospital del Mar-IMIM-UAB, CIBERFES, Institute Carlos III, Barcelona, Barcelona, Spain
| | - Philippe Halbout
- The International Osteoporosis Foundation (IOF), Nyon, Switzerland
| | - Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Andreas Kurt
- Department of Orthopaedic and Trauma Surgery, Community Clinics Middle Rhine, Campus Kemperhof, Koblenz, Germany
| | - Radmila Matijevic
- Faculty of Medicine, Clinic for Orthopedic Surgery and Traumatology, University of Novi Sad, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Regis P Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liege, CHU de Liège, Liège, Belgium
| | - Sansin Tuzun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa School of Medicine, Istanbul University- Cerrahpaşa, Istanbul, Turkey
| | - Nicola Veronese
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy.
| | - Rene Rizzoli
- Division of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Maria Luisa Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Maria-Luisa Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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Ramirez Zegarra R, Degennaro V, Brandi ML, Cagninelli G, Casciaro S, Celora G, Conversano F, Lombardi FA, Pisani P, Ghi T. Longitudinal changes of the femoral bone mineral density from first to third trimester of pregnancy: bone health assessment by means of non-ionizing REMS technology. Aging Clin Exp Res 2024; 36:31. [PMID: 38334854 PMCID: PMC10858072 DOI: 10.1007/s40520-023-02677-4] [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] [Received: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Throughout the pregnancy, there is a substantial transfer of calcium from the maternal skeleton to the fetus, which leads to a transient net reduction of the maternal bone mineral density. AIMS To assess longitudinally the changes in the bone mineral density at the femoral neck between the first and third trimester of pregnancy in a cohort of healthy participants using Radiofrequency Echographic Multi Spectrometry (REMS) technology. METHODS Prospective, cohort study conducted at the University hospital of Parma, Italy between July 2022 and February 2023. We recruited healthy participants with an uncomplicated singleton pregnancy before 14 completed weeks of gestation. All included participants were submitted to a sonographic examination of the femoral neck to assess the bone mineral density (and the corresponding Z-score values) using REMS at 11-13 and 36-38 weeks of pregnancy. The primary outcome was the change in the bone mineral density values at the maternal femoral neck between the first and third trimester of pregnancy. RESULTS Over a period of 7 months, a total of 65 participants underwent bone mineral density measurement at the femoral neck at first and third trimester of the pregnancy using REMS. A significant reduction of the bone mineral density at the femoral neck (0.723 ± 0.069 vs 0.709 ± 0.069 g/cm2; p < 0.001) was noted with a mean bone mineral density change of - 1.9 ± 0.6% between the first and third trimester of pregnancy. At multivariable linear regression analysis, none of the demographic or clinical variables of the study population proved to be independently associated with the maternal bone mineral density changes at the femoral neck. CONCLUSIONS Our study conducted on a cohort of healthy participants with uncomplicated pregnancy demonstrates that there is a significant reduction of bone mineral density at femoral neck from early to late gestation.
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Affiliation(s)
- Ruben Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Valentina Degennaro
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Maria Luisa Brandi
- Fondazione Italiana per la Ricerca sulle Malattie dell'Osso (F.I.R.M.O.), Florence, Italy
| | - Greta Cagninelli
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Sergio Casciaro
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
- Echolight Spa, Lecce, Italy
| | - Gabriella Celora
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Francesco Conversano
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
- Echolight Spa, Lecce, Italy
| | | | - Paola Pisani
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy.
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Cathey A, Tamayo-Ortiz M, Tamayo-Orozco J, Meeker JD, Peterson KE, Trejo-Valdivia B, Téllez-Rojo MM, Watkins DJ. Calcium supplementation and body mass index modify associations between prenatal phthalate exposure and perinatal bone ultrasound measures among pregnant women. ENVIRONMENTAL RESEARCH 2023; 233:116513. [PMID: 37385416 PMCID: PMC10529894 DOI: 10.1016/j.envres.2023.116513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/09/2023] [Accepted: 06/24/2023] [Indexed: 07/01/2023]
Abstract
Phthalates have endocrine activity that may interfere with bone health, particularly during pregnancy and the early postpartum period, when bone resorption increases. We evaluated associations between prenatal phthalate exposure and perinatal bone health among 289 mothers in the ELEMENT birth cohort in Mexico City who were randomized upon recruitment to receive 1,200 mg daily calcium supplementation or placebo throughout pregnancy. Spot urine samples at up to three timepoints during pregnancy were assayed for 9 phthalate metabolites. Bone integrity was assessed by quantitative ultrasound speed of sound (SOS) measurements of the phalange and distal radius at 3, 6, and 8 months of pregnancy and 1, 3, 7, and 12 months postpartum. Geometric means of specific gravity-corrected phthalate concentrations were used as overall measures of prenatal exposure. Linear mixed effect models estimated associations between phthalate exposure and repeated perinatal bone SOS measures, adjusting for age, pre-pregnancy body mass index (BMI), education, parity, calcium supplementation, and month of pregnancy/postpartum. Effect modification by calcium supplementation and BMI were assessed in sensitivity analyses. An interquartile range increase in MEP and MiBP increased pregnancy phalange z-scores (β: 0.11; 95%CI: 0.003, 0.31 and β: 0.15; 95%CI: 0.00,0.42, respectively). Higher concentrations of several phthalate metabolites resulted in lower SOS measures among women who received calcium supplements (compared to placebo group) but higher SOS measures among women with a BMI≥25 (compared to BMI<25). These results suggest that phthalate exposure may interfere with bone remodeling during pregnancy, and that consideration of effect modifiers is paramount to fully understand the effects of environmental exposures on bone health.
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Affiliation(s)
- Amber Cathey
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Marcela Tamayo-Ortiz
- Occupational Health Research Unit, Mexican Social Security Institute, Mexico City, Mexico.
| | - Juan Tamayo-Orozco
- Mexican Committee for the Prevention of Osteoporosis, Mexico City, Mexico
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Belem Trejo-Valdivia
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Martha Maria Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Deborah J Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
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Qian Y, Wang L, Yu L, Huang W. Pregnancy- and lactation-associated osteoporosis with vertebral fractures: a systematic review. BMC Musculoskelet Disord 2021; 22:926. [PMID: 34732196 PMCID: PMC8567545 DOI: 10.1186/s12891-021-04776-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/06/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To review, analyze and characterize the pregnancy and lactation-related osteoporosis (PLO) with vertebral fractures based on the extraction data in the previous studies. METHODS A comprehensive literature search of electronic databases including the PubMed, Embase and Web of Science was conducted from January 1st,1990 to December 1st, 2020. The enrolled data were pooled to analyze the baseline characteristics, clinical features, risk factors and treatment options. RESULTS A total of 65 articles with 338 cases were enrolled for data extraction. The enrolled cases aged from 19 to 47 years, with a mean value of 35.7 years old. The average body mass index (BMI) was 22.2 kg/m2 ranged from 16.0 to 39.0 kg/m2. Of the 173 cases, 149 cases with vertebral fractures occurred in the first pregnancy, 19 cases in the second pregnancy, four cases in the third pregnancy and one case in the fourth pregnancy. Up to 91.5% of the back pain occurred within the last 3 months of pregnancy and the first 3 months after delivery. The most involved vertebral levels were L2, L1 and T12 accounting for 32.6% of all the fractures. The average fracture numbers were 4.4 levels per patient. The lumbar Z-scores were mostly recorded with a mean value of - 3.2 ranged from - 7.8 to 0. CONCLUSIONS PLO with vertebral fractures is a rare clinical entity, which is more likely to occur in older and thinner pregnant women. Back pain is the clinical complaint and mostly occurs in the late pregnancy and early lactation periods. Most vertebral fractures appear in the first pregnancy but it can occur in any time of pregnancy. Thoracolumbar region is the mostly involved region. As compared with postmenopausal osteoporotic fractures, PLO usually has multiple levels fractures. Bisphosphonates are the most widely used treatment so far, however, many factors need to be taken into account to decide which drug to choose in PLO and further studies are necessary for clear recommendation in the future.
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Affiliation(s)
- Ying Qian
- Endocrinology Department, 960 Hospital of People’s Liberation Army, NO.25 Shifan Road, Jinan, Shandong 250031 People’s Republic of China
| | - Lei Wang
- Orthopaedic Department, 960 Hospital of People’s Liberation Army, NO.25 Shifan Road, Jinan, Shandong 250031 People’s Republic of China
| | - Lili Yu
- Medical Information Department, 960 Hospital of People’s Liberation Army, NO.25 Shifan Road, Jinan, Shandong 250031 People’s Republic of China
| | - Weimin Huang
- Orthopaedic Department, 960 Hospital of People’s Liberation Army, NO.25 Shifan Road, Jinan, Shandong 250031 People’s Republic of China
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Osorio-Yáñez C, Sanchez-Guerra M, Solano M, Baccarelli A, Wright R, Sanders AP, Tellez-Rojo MM, Tamayo-Ortiz M. Metal exposure and bone remodeling during pregnancy: Results from the PROGRESS cohort study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 282:116962. [PMID: 33823308 PMCID: PMC11064930 DOI: 10.1016/j.envpol.2021.116962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 02/20/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
Pregnancy is characterized by high bone remodeling and might be a window of susceptibility to the toxic effects of metals on bone tissue. The aim of this study was to assess associations between metals in blood [lead (Pb), cadmium (Cd)and arsenic (As)] and bone remodeling during pregnancy. We studied pregnant woman from the PROGRESS Cohort (Programming Research in Obesity, Growth, and Environment and Social Stress). We measured concentrations of metals in blood and obtained measures of bone remodeling by quantitative ultrasound (QUS) at the radius in the second and third trimester of pregnancy. To account for chronic lead exposure, we measured lead in tibia and patella one-month postpartum with K-shell X-ray fluorescence. We assessed cross-sectional and longitudinal associations between multiple-metal concentrations and QUS z-scores using linear regression models and linear mixed models adjusted for potential confounders. Third trimester blood Cd concentrations were marginal associated with lower QUS z-scores [-0.16 (95% CI: -0.33, 0.007); P-Value = 0.06]. Mixed models showed that blood Cd was longitudinally and marginally associated with an average of -0.10 z-score (95% CI: -0.21, 0.002; P-Value = 0.06) over the course of pregnancy. Associations for Pb and As were all inverse however none reached significance. Additionally, bone Pb concentrations in patella, an index of cumulative exposure, were significantly associated with -0.06 z-score at radius (95% CI: -0.10, -0.01; P-Value = 0.03) during pregnancy. Pb and Cd blood levels are associated with lower QUS distal radius z-scores in pregnant women. Bone Pb concentrations in patella were negatively associated with z-score at radius showing the long-term effects of Pb on bone tissue. However, we cannot exclude the possibility of reverse causality for patella Pb and radius z-score associations. Our results support the importance of reducing women's metal exposure during pregnancy, as metals exposure during pregnancy may have consequences for bone strength later in life. The main finding of our study is the association between Cd blood levels and radius z-score during pregnancy. Bone lead in patella was also negatively associated with radius z-scores.
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Affiliation(s)
- Citlalli Osorio-Yáñez
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Instituto de Investigaciones Biomedicas, Universidad Nacional Autonoma de Mexico (UNAM), Ciudad Universitaria S/N, Mexico
| | - Marco Sanchez-Guerra
- Department of Developmental Neurobiology, National Institute of Perinatology, Montes Urales 800, Lomas Virreyes, Mexico City, 1100, Mexico
| | - Maritsa Solano
- Center for Evaluation Research & Surveys, National Institute of Public Health, Cuernavaca, Morelos, 62100, Mexico
| | - Andrea Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Robert Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, NY, 10029, USA
| | - Alison P Sanders
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, NY, 10029, USA
| | - Martha Maria Tellez-Rojo
- Center for Evaluation Research & Surveys, National Institute of Public Health, Cuernavaca, Morelos, 62100, Mexico.
| | - Marcela Tamayo-Ortiz
- Occupational Research Unit, Mexican Social Security Institute (IMSS), Mexico City, Mexico
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Yoshikata H, Tsugawa N, Watanabe Y, Tsuburai T, Chaki O, Hirahara F, Miyagi E, Sakakibara H, Uenishi K, Okano T. 25-Hydroxyvitamin D profiles and maternal bone mass during pregnancy and lactation in Japanese women. J Bone Miner Metab 2020; 38:99-108. [PMID: 31432265 DOI: 10.1007/s00774-019-01032-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/13/2019] [Indexed: 01/28/2023]
Abstract
Vitamin D deficiency is observed worldwide and represents a health hazard for mothers, infants and elderly persons. We know that many young Japanese women experience vitamin D insufficiency; however, there is a lack of knowledge regarding the serum 25-hydroxyvitamin D [25(OH)D] profile of pregnant Japanese women and of the association between maternal 25(OH)D level and maternal bone mass during pregnancy and lactation. In this longitudinal study, 160 pregnant Japanese women were enrolled; of them, 68 have been followed-up from the first trimester through at least 1 year of breast-feeding. We estimated serum 25(OH)D levels, intact PTH levels, calcaneus quantitative ultrasound (QUS: T score) scores, bone mineral density at the distal one-third of the radius, dietary intakes according to the Food Frequency Questionnaire, and sunlight exposure times. We found that Vitamin D deficiency is prevalent in Japanese women, irrespective of pregnancy or lactation, and our analysis suggested that 25(OH)D levels and BMI in the first trimester were related to the lactating women's bone mass from after delivery to 1 year after delivery.
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Affiliation(s)
- Hiromi Yoshikata
- Yoshikata Obstetrics and Gynecology Clinic, 2430 Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan.
- Department of Gynecology, Yokohama City University Medical Center Hospital, Yokohama, Japan.
| | | | - Yuna Watanabe
- Niigata University of Health and Welfare, Niigata, Japan
| | - Taku Tsuburai
- Department of Gynecology, Yokohama City University Medical Center Hospital, Yokohama, Japan
| | - Osamu Chaki
- Department of Gynecology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center Hospital, Yokohama, Japan
| | - Kazuhiro Uenishi
- Laboratory of Physiological Nutrition, Kagawa Nutrition University, Sakado, Japan
| | - Toshio Okano
- Department of Hygienic Sciences, Kobe Pharmaceutical University, Kobe, Japan
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Liu XS, Wang L, de Bakker CMJ, Lai X. Mechanical Regulation of the Maternal Skeleton during Reproduction and Lactation. Curr Osteoporos Rep 2019; 17:375-386. [PMID: 31755029 PMCID: PMC7373497 DOI: 10.1007/s11914-019-00555-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review summarizes recently published data on the effects of pregnancy and lactation on bone structure, mechanical properties, and mechano-responsiveness in an effort to elucidate how the balance between the structural and metabolic functions of the skeleton is achieved during these physiological processes. RECENT FINDINGS While pregnancy and lactation induce significant changes in bone density and structure to provide calcium for fetal/infant growth, the maternal physiology also comprises several innate compensatory mechanisms that allow for the maintenance of skeletal mechanical integrity. Both clinical and animal studies suggest that pregnancy and lactation lead to adaptations in cortical bone structure to allow for rapid calcium release from the trabecular compartment while maintaining whole bone stiffness and strength. Moreover, extents of lactation-induced bone loss and weaning-induced recovery are highly dependent on a given bone's load-bearing function, resulting in better protection of the mechanical integrity at critical load-bearing sites. The recent discovery of lactation-induced osteocytic perilacunar/canalicular remodeling (PLR) indicates a new means for osteocytes to modulate mineral homeostasis and tissue-level mechanical properties of the maternal skeleton. Furthermore, lactation-induced PLR may also play an important role in maintaining the maternal skeleton's load-bearing capacity by altering osteocyte's microenvironment and modulating the transmission of anabolic mechanical signals to osteocytes. Both clinical and animal studies show that parity and lactation have no adverse, or a positive effect on bone strength later in life. The skeletal effects during pregnancy and lactation reflect an optimized balance between the mechanical and metabolic functions of the skeleton.
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Affiliation(s)
- X Sherry Liu
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 332A Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, USA.
| | - Liyun Wang
- Center for Biomechanical Research, Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Chantal M J de Bakker
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Xiaohan Lai
- School of Life Sciences, University of Science and Technology of China, Hefei, China
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Kovacs CS. Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery. Physiol Rev 2016; 96:449-547. [PMID: 26887676 DOI: 10.1152/physrev.00027.2015] [Citation(s) in RCA: 251] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ∼30 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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Affiliation(s)
- Christopher S Kovacs
- Faculty of Medicine-Endocrinology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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9
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Ettinger AS, Lamadrid-Figueroa H, Mercado-García A, Kordas K, Wood RJ, Peterson KE, Hu H, Hernández-Avila M, Téllez-Rojo MM. Effect of calcium supplementation on bone resorption in pregnancy and the early postpartum: a randomized controlled trial in Mexican women. Nutr J 2014; 13:116. [PMID: 25511814 PMCID: PMC4289552 DOI: 10.1186/1475-2891-13-116] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 12/11/2014] [Indexed: 12/04/2022] Open
Abstract
Background Calcium needs are physiologically upregulated during pregnancy and lactation to meet demands of the developing fetus and breastfeeding infant. Maternal calcium homeostasis is maintained by hormonal adaptive mechanisms, thus, the role of dietary calcium supplementation in altering maternal responses to fetal-infant demand for calcium is thought to be limited. However, increased calcium absorption is directly related to maternal calcium intake and dietary supplementation has been suggested to prevent transient bone loss associated with childbearing. Methods In a double-blind, randomized placebo-controlled trial, we randomly assigned 670 women in their first trimester of pregnancy to 1,200 mg/day calcium (N = 334) or placebo (N = 336). Subjects were followed through 1-month postpartum and the effect on urinary cross-linked N-telopeptides (NTx) of type I collagen, a specific marker of bone resorption, was evaluated using an intent-to-treat analysis. Women with a baseline and at least one follow-up measurement (N = 563; 84%) were included. Subsequent analyses were conducted stratifying subjects by compliance assessed using pill counts. In random subsets of participants, bone-specific alkaline phosphatase (BAP) (N = 100) and quantitative ultrasound (QUS) (N = 290) were also measured. Results Calcium was associated with an overall reduction of 15.8% in urinary NTx relative to placebo (p < 0.001). Among those who consumed ≥50%, ≥67%, and ≥75% of pills, respectively, the effect was associated with 17.3%, 21.3%, and 22.1% reductions in bone resorption (all p < 0.001). There was no significant effect of calcium on bone formation measured by BAP. However, by 1-month postpartum, those in the calcium group had significantly lower NTx/BAP ratios than those in the placebo group (p = 0.04) indicating a net reduction in bone loss in the supplement group by the end of follow-up. Among subjects who consumed ≥50% and ≥75% of pills, respectively, calcium was also associated with an increase of 26.3 m/s (p = 0.03) and 59.0 m/s (p = 0.009) in radial SOS relative to placebo by 1-month postpartum. Conclusions Calcium administered during pregnancy and the early postpartum period, to women with intakes around adequacy, was associated with reduced bone resorption and, thus, may constitute a practical intervention to prevent transient skeletal loss associated with childbearing. Trial registration ClinicalTrials.gov Identifier NCT00558623
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Affiliation(s)
- Adrienne S Ettinger
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale Schools of Public Health and Medicine, 1 Church Street 6th floor, New Haven, CT 06510, USA.
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Yumusakhuylu Y, Turgut ST, Icagasioglu A, Baklacioglu HS, Atlig RS, Murat S, Suer N. Bone mineral changes during pregnancy and lactation. Gynecol Endocrinol 2013; 29:763-6. [PMID: 23815509 DOI: 10.3109/09513590.2013.801444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Significant calcium transfer from the mother to the fetus and infant occurs during pregnancy and lactation, theoretically placing the mother at an increased risk for osteoporosis. The relationship between pregnancy, breast-feeding and low bone mass is controversial. In this study we aimed to elucidate the relationship between pregnancy, breast-feeding and bone mass in third trimester pregnants, at least 3 months lactating mothers, and healthy young nulliporous women by using quantitative ultrasonometry. METHOD The study included 120 women divided in three groups: third trimester pregnants, at least 3 months lactating mothers and healthy young nulliporous women. Demographics, total lactation time, number of pregnancies, births and miscarriages-abortions were recorded. Study groups underwent quantitative ultrasonometry measurement at midtibial shaft. Values of the ultrasonometry variables were calculated and compared for groups. RESULTS There were no significant differences among the groups with respect to parameters of age, age at menarche, smoking, alcohol intake and physical exercise in all of the three groups (p > 0.05). No differences were found among the three groups in analyzed variables, when comparing SOS, T- and Z-scores mid-tibial shaft quantitative ultrasonometry. CONCLUSION No statistically significant associations were found between ultrasonometry variables and pregnancy, breast-feeding or nulliparity.
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Affiliation(s)
- Yasemin Yumusakhuylu
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Goztepe-Istanbul, Turkey.
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11
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Abstract
Parathyroid disorders are not common among pregnant women, but harbor a significant morbidity and mortality potential if they remain unrecognized and untreated. The symptoms caused by abnormally low or high blood free calcium level are mostly non-specific in the initial stages, thus when recognized might pose a real danger. Here we will survey the alterations in calcium metabolism induced by pregnancy, and describe the clinical manifestations, diagnosis and treatment of parathyroid and other calcium metabolism disorders during pregnancy. The current literature on the impact of calcium and vitamin D deficiency during pregnancy will also be reviewed.
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Affiliation(s)
- Ilana Parkes
- Department of Obstetrics & Gynecology, Hadassah Ein Kerem University Hospital, Jerusalem, Israel
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12
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Vanderspank D, Bernier SM, Sopper MM, Watson P, Mottola MF. Activity restriction increases deoxypyridinoline excretion in hospitalized high-risk pregnant women. Biol Res Nurs 2012; 16:7-15. [PMID: 23079370 DOI: 10.1177/1099800412463120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Activity restriction (AR), one of the most common interventions used in high-risk pregnancies, may exacerbate loss of bone mass. The purpose of this study was to determine changes over time in bone resorption in hospitalized AR women during late pregnancy. METHODS This was a short-term prospective study conducted in two tertiary-care obstetric hospitals. We measured urinary deoxypyridinoline (Dpd) excretion, a marker of bone resorption, once per week in a convenience sample of 14 hospitalized AR women in the third trimester and compared values at 28-31 and 34-36 weeks' gestation to those of 11 ambulatory control women. Both groups completed a bone-loading questionnaire, 3-day food intake record, and pedometer step counts at the same gestational age. RESULTS Urinary Dpd excretion increased from Days 1-7 (2.60 ± 0.32 nmol/mmol creatinine) to Days 22-28 (5.36 ± 0.83 nmol/mmol creatinine; p ≤ .05). Dpd excretion was higher in AR women (4.51 ± 0.31 nmol/mmol creatinine) than ambulatory women (2.72 ± 0.39 nmol/mmol creatinine) at 34-36 weeks' gestation (p ≤ .05). Energy intake between ambulatory and AR women was not different (p ≥ .05). All women met the daily requirements for calcium and vitamin D intake during pregnancy. Average daily pedometer steps for the AR women were significantly less compared to controls (1,329 ± 936 and 8,024 ± 1,890 steps/day, respectively; p ≤ .05). CONCLUSIONS AR leads to increased bone resorption in hospitalized pregnant women, which may impact future risk of developing osteopenia and osteoporosis.
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Affiliation(s)
- Dana Vanderspank
- 1R. Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
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13
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Calderon-Garcia JF, Lavado-Garcia JM, Martin RR, Moran JM, Canal-Macias ML, Pedrera-Zamorano JD. Bone ultrasound and physical activity in postmenopausal Spanish women. Biol Res Nurs 2012; 15:416-21. [PMID: 22997347 DOI: 10.1177/1099800412459800] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We studied the effects of moderate physical activity on bone mass in healthy postmenopausal women as assessed by quantitative bone ultrasound. We enrolled a total of 326 postmenopausal women (60.95 ± 8.51 years old and 13.02 ± 9.52 years since menopause) and categorized them by weekly physical activity in their leisure time (sedentary, moderate, and active). We administered a questionnaire on general health and diet and measured bone density by ultrasound on phalanges II-V in the nondominant hand. We found no significant difference in the amplitude-dependent speed of sound (Ad-SoS; p > .05) between sedentary and active women. We concluded that the changes induced by moderate physical activity on bone mass are minimal in healthy postmenopausal women.
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Affiliation(s)
- Julian F Calderon-Garcia
- 1Metabolic Bone Diseases Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Caceres, Spain
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14
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Abstract
Although the demand for additional calcium during pregnancy is recognized, the dietary reference intake for calcium was lowered for pregnant women in 1997 to amounts recommended for nonpregnant women (1,000 mg/day), and recently (November 2010) the Institute of Medicine report upheld the 1997 recommendation. It has been frequently reported that women of childbearing age do not consume the dietary reference intake for calcium and that calcium intake in the United States varies among ethnic groups. Women who chronically consume suboptimal amounts of calcium (<500 mg/day) may be at risk for increased bone loss during pregnancy. Women who begin pregnancy with adequate intake may not need additional calcium, but women with suboptimal intakes (<500 mg) may need additional amounts to meet both maternal and fetal bone requirements. The objective of this review is to elucidate the changes in calcium metabolism that occur during pregnancy as well as the effect of maternal calcium intake on both maternal and fetal outcomes.
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Affiliation(s)
- Andrea N Hacker
- Children's Hospital Oakland Research Institute, Oakland, California, USA.
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15
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Brandao KL, Mottola MF, Gratton R, Maloni J. Bone Status in Activity-Restricted Pregnant Women Assessed Using Calcaneal Quantitative Ultrasound. Biol Res Nurs 2011; 15:205-12. [DOI: 10.1177/1099800411423807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Pregnancy-induced bone loss may be further exacerbated by activity restriction (AR). The authors compared the bone status of AR hospitalized (≥7 days) pregnant women in the third trimester to ambulatory (AM) women at the same gestational age, using a prospective cross-sectional design. Method: AR was quantified in AR women by daily step counts using a pedometer for 7 consecutive days. Bone status was evaluated in the left and right calcaneus bones of both AR ( n = 13) and AM ( n = 20) women using quantitative ultrasound (QUS). Results: AR women took an average of 1,504 ± 1,377 steps/day. Speed of sound scores (1,543.05 ± 41.97 m/s vs. 1,569.60 ± 46.12 m/s) and broadband ultrasound attenuation (BUA) scores (107.93 ± 9.59 dB/MHz vs. 114.69 ± 17.06 dB/MHz) were not different between the AR and AM groups, respectively ( p > .05). However, bone stiffness index (SI) scores (84.0 ± 16.2 vs. 95.8 ± 22.1, respectively, p < .05) were different between groups, indicating a greater relative risk of future fracture in the AR women. Conclusion: Increased fracture risk appears to be a negative side effect incurred through an average of 16 days of hospitalized AR in late pregnancy. Further investigations using a larger sample size are necessary to evaluate the effect of antepartum AR on bone status in the postpartum period to determine if bone status is further attenuated by breastfeeding or if recovery occurs with resumption of ambulation and return of menses and to assess future risk in these women as they age. Prenatal care providers should be made aware of these risks.
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Affiliation(s)
- Kristen L. Brandao
- R. Samuel McLaughlin Foundation—Exercise and Pregnancy Laboratory, School of Kinesiology, The University of Western Ontario, London, Ontario, Canada
| | - Michelle F. Mottola
- R. Samuel McLaughlin Foundation—Exercise and Pregnancy Laboratory, School of Kinesiology, The University of Western Ontario, London, Ontario, Canada
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
- Child Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Robert Gratton
- Child Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
- Department of Obstetrics and Gynecology, St. Joseph’s Health Centre, London, Ontario, Canada
| | - Judith Maloni
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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