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Maroudias G, Vrachnis D, Fotiou A, Loukas N, Mantzou A, Pergialiotis V, Valsamakis G, Machairiotis N, Stavros S, Panagopoulos P, Vakas P, Kanaka-Gantenbein C, Drakakis P, Vrachnis N. Measurement of Calprotectin and PTH in the Amniotic Fluid of Early Second Trimester Pregnancies and Their Impact on Fetuses with Growth Disorders: Are Their Levels Related to Oxidative Stress? J Clin Med 2024; 13:855. [PMID: 38337548 PMCID: PMC10856459 DOI: 10.3390/jcm13030855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: During the early stages of human fetal development, the fetal skeleton system is chiefly made up of cartilage, which is gradually replaced by bone. Fetal bone development is mainly regulated by the parathyroid hormone parathormone (PTH) and PTH-related protein, with specific calprotectin playing a substantial role in cell adhesion and chemotaxis while exhibiting antimicrobial activity during the inflammatory osteogenesis process. The aim of our study was to measure the levels of PTH and calprotectin in early second trimester amniotic fluid and to carry out a comparison between the levels observed among normal full-term pregnancies (control group) and those of the groups of embryos exhibiting impaired or enhanced growth. Methods: For the present prospective study, we collected amniotic fluid samples from pregnancies that underwent amniocentesis at 15 to 22 weeks of gestational age during the period 2021-2023. Subsequently, we followed up on all pregnancies closely until delivery. Having recorded fetal birthweights, we then divided the neonates into three groups: small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). Results: In total, 64 pregnancies, including 14 SGA, 10 LGA, and 40 AGA fetuses, were included in our study. Both substances were detected in early second trimester amniotic fluid in both groups. Concentrations of calprotectin differed significantly among the three groups (p = 0.033). AGA fetuses had a lower mean value of 4.195 (2.415-6.425) IU/mL, whereas LGA fetuses had a higher mean value of 6.055 (4.887-13.950) IU/mL, while SGA fetuses had a mean value of 5.475 (3.400-9.177) IU/mL. Further analysis revealed that only LGA fetuses had significantly higher calprotectin concentrations compared to AGA fetuses (p = 0.018). PTH concentration was similar between the groups, with LGA fetuses having a mean value of 13.18 (9.51-15.52) IU/mL, while SGA fetuses had a mean value of 14.18 (9.02-16.00) IU/mL, and AGA fetuses had similar concentrations of 13.35 (9.05-15.81) IU/mL. The differences in PTH concentration among the three groups were not statistically significant (p = 0.513). Conclusions: Calprotectin values in the amniotic fluid in the early second trimester were higher in LGA fetuses compared to those in the SGA and AGA categories. LGA fetuses can possibly be in a state of low-grade chronic inflammation due to excessive fat deposition, causing oxidative stress in LGA fetuses and, eventually, the release of calprotectin. Moreover, PTH concentrations in the amniotic fluid of early second trimester pregnancies were not found to be statistically correlated with fetal growth abnormalities in either LGA or SGA fetuses. However, the early time of collection and the small number of patients in our study should be taken into account.
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Affiliation(s)
- George Maroudias
- Department of Obstetrics and Gynecology, Tzaneio General Hospital, 18536 Athens, Greece
| | - Dionysios Vrachnis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.V.); (A.F.)
| | - Alexandros Fotiou
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.V.); (A.F.)
| | - Nikolaos Loukas
- Department of Obstetrics and Gynecology, Tzaneio General Hospital, 18536 Athens, Greece
| | - Aimilia Mantzou
- First Department of Paediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece (C.K.-G.)
| | - Vasileiοs Pergialiotis
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece;
| | - George Valsamakis
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieion Hospital, 11528 Athens, Greece; (G.V.)
| | - Nikolaos Machairiotis
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, 12462 Athens, Greece (P.P.)
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, 12462 Athens, Greece (P.P.)
| | - Periklis Panagopoulos
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, 12462 Athens, Greece (P.P.)
| | - Panagiotis Vakas
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieion Hospital, 11528 Athens, Greece; (G.V.)
| | - Christina Kanaka-Gantenbein
- First Department of Paediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece (C.K.-G.)
| | - Petros Drakakis
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, 12462 Athens, Greece (P.P.)
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, 12462 Athens, Greece (P.P.)
- Vascular Biology, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17, UK
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Nerius L, Vogel M, Ceglarek U, Kiess W, Biemann R, Stepan H, Kratzsch J. Bone turnover in lactating and nonlactating women. Arch Gynecol Obstet 2023; 308:1853-1862. [PMID: 37707552 PMCID: PMC10579129 DOI: 10.1007/s00404-023-07189-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE During lactation, bone turnover increases, reflecting the mobilization of Calcium from maternal skeletal stores and resulting in bone loss. However, mechanisms are not yet fully understood, and previous studies have been comparatively small. We aim to assess bone metabolism during lactation by comparing bone-metabolism-related-parameters between large cohorts of lactating and nonlactating women. METHODS In a retrospective cohort study, we recruited 779 postpartum women and 742 healthy, nonpregnant, nonlactating controls. Postpartum women were examined 3 and 6 months after delivery and retrospectively assigned to either the exclusively breastfeeding (exc-bf) group if they had exclusively breastfed or the nonexclusively breastfeeding (nonexc-bf) group if they had not exclusively breastfed up to the respective visit. Serum levels of PTH, Estradiol, total Calcium, Phosphate, and bone turnover markers (ßCTX, P1NP, Osteocalcin) were compared between the groups. RESULTS Bone turnover markers were significantly increased in exc-bf and nonexc-bf women compared with the controls (all ps < .001). ßCTX was approximately twice as high in exc-bf women than in the controls. PTH levels were marginally higher in exc-bf (p < .001) and nonexc-bf women (p = .003) compared with the controls (6 months). Estradiol was suppressed in exc-bf women compared with the controls (p < .001, 3 months). CONCLUSION Exc-bf and even nonexc-bf states are characterized by an increase in bone formation and resorption markers. The PTH data distribution of exc-bf, nonexc-bf, and control groups in the underpart of the reference range suggest that lactational bone loss is relatively independent of PTH.
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Affiliation(s)
- Lena Nerius
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103, Leipzig, Germany
| | - Mandy Vogel
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103, Leipzig, Germany
| | - Uta Ceglarek
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103, Leipzig, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University of Leipzig, 04103, Leipzig, Germany
| | - Ronald Biemann
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University of Leipzig, 04103, Leipzig, Germany
| | - Jürgen Kratzsch
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany.
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Stoica AB, Mărginean C. The Impact of Vitamin D Deficiency on Infants' Health. Nutrients 2023; 15:4379. [PMID: 37892454 PMCID: PMC10609616 DOI: 10.3390/nu15204379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Vitamin D is an essential nutrient that plays a vital role in bone health and musculoskeletal development. The aim of this narrative review is to present up-to-date information about the impact of vitamin D deficiency (VDD) on the health status of infants in their first year of life. Vitamin D is indispensable for skeletal growth and bone health, and emerging research suggests that it may also have significant roles in maternal and fetal health. VDD affects a large proportion of infants according to current guidelines. However, its prevalence varies depending on geographic location, skin pigmentation, and the time of year. Based on current guidelines for normal vitamin D levels and recommended daily intake, studies suggest that VDD is a global health issue with potentially significant implications for those at risk, especially infants. Our understanding of the role of vitamin D has improved significantly in the last few decades. Systematic reviews and meta-analyses investigating the effect of vitamin D on preterm birth, low birth weight, anthropometric parameters, and health outcomes such as infectious diseases in infants, have found conflicting or inconsistent results. It is important to encourage further research to fill in these knowledge gaps and develop national or global strategies that ease the burden of VDD, especially in groups at risk.
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Affiliation(s)
- Andreea Bianca Stoica
- Doctoral School of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania
| | - Claudiu Mărginean
- Department of Obstetrics and Gynecology 2, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania;
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Siva S, Liao Q, Abbas A, Periasamy K. Bilateral atraumatic femoral neck fractures resulting from transient osteoporosis of the hip. BMJ Case Rep 2022; 15:e247967. [PMID: 36253010 PMCID: PMC9577900 DOI: 10.1136/bcr-2021-247967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A woman in her mid-30s presented to the orthopaedic team, unable to mobilise, shortly after her caesarean section. On questioning, she reported 10 weeks of atraumatic right hip pain. A radiograph revealed a displaced right subcapital neck of femur fracture. An MRI confirmed this, as well as identifying a minimally displaced left subcapital neck of femur fracture. She underwent a right total hip replacement and internal fixation of the left hip. A dual energy X-ray absorptiometry (DEXA) scan showed severe osteoporosis, and a diagnosis of transient osteoporosis of the hip was made. She was seen by the bone metabolism team and given calcium and vitamin D medication. Although atraumatic hip fractures are rare in young patients, disproportionate or persisting hip pain in pregnant patients should raise the index of suspicion and prompt further investigation in the form of an MRI. This will allow timely management of hip fractures and improve patient outcomes.
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Affiliation(s)
- Soorya Siva
- Orthopaedics, Wishaw General Hospital, Wishaw, UK
| | - Quintin Liao
- Orthopaedics, Wishaw General Hospital, Wishaw, UK
| | - Ammar Abbas
- Orthopaedics, Wishaw General Hospital, Wishaw, UK
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Ó Breasail M, Ward KA, Schoenbuchner SM, Ceesay M, Mendy M, Jarjou LM, Moore SE, Prentice A. Pregnancy-Related Change in pQCT and Bone Biochemistry in a Population With a Habitually Low Calcium Intake. J Bone Miner Res 2021; 36:1269-1280. [PMID: 33784438 DOI: 10.1002/jbmr.4295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/07/2022]
Abstract
In pregnancy, changes in maternal calcium (Ca) economy occur to satisfy fetal Ca demand. It is unclear whether maternal mineral reserves facilitate these requirements and no data exist from sub-Saharan Africa. The aim was to determine skeletal changes with peripheral quantitative computed tomography (pQCT) and bone biochemistry between early second and third trimesters. Pregnant rural Gambians aged 18 to 45 years (n = 467) participating in a trial of antenatal nutritional supplements (ISRCTN49285450) had pQCT scans and blood collections at mean (SD) 14 (3) and 31 (1) weeks' gestation. Outcomes were pQCT: radius/tibia 4% total volumetric bone mineral density (vBMD), trabecular vBMD, total cross-sectional area (CSA), 33%/38% radius/tibia cortical vBMD, bone mineral content (BMC), total CSA; biochemistry: collagen type 1 cross-linked β-C-telopeptide (β-CTX), type 1 procollagen N-terminal (P1NP), parathyroid hormone (PTH), and 1,25(OH)2 D. Independent t tests tested whether pooled or within-group changes differed from 0. Multiple regression was performed adjusting for age. Data for change are expressed as mean (confidence interval [CI] 2.5, 97.5%). Radius trabecular vBMD, cortical vBMD, and BMC increased by 1.15 (0.55, 1.75)%, 0.41 (0.24, 0.58)%, and 0.47 (0.25, 0.69)%. Tibia total and trabecular vBMD increased by 0.34 (0.15, 0.54)% and 0.46 (0.17, 0.74)%, while tibia cortical vBMD, BMC, and cortical CSA increased by 0.35 (0.26, 0.44)%, 0.55 (0.41, 0.68)% and 0.20 (0.09, 0.31)%, respectively. CTX, PTH, and 1,25(OH)2 D increased by 23.0 (15.09, 29.29)%, 13.2 (8.44, 19.34)%, and 21.0 (17.67, 24.29)%, while P1NP decreased by 32.4 (-37.19, -28.17)%. No evidence of mobilization was observed in the peripheral skeleton. Resorption, although higher in late versus early gestation, was lower throughout pregnancy compared with non-pregnant non-lactating (NPNL) in the same community. Formation was lower in late pregnancy than in early, and below NPNL levels. This suggests a shift in the ratio of resorption to formation. Despite some evidence of change in bone metabolism, in this population, with habitually low Ca intakes, the peripheral skeleton was not mobilized as a Ca source for the fetus. © 2021 crown copyright . Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). The article published with the permission of the Controller of HMSO and the Queen's Printer of Scotland..
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Affiliation(s)
- Mícheál Ó Breasail
- MRC Nutrition and Bone Health Research Group, University of Cambridge, Cambridge, UK
| | - Kate A Ward
- MRC Nutrition and Bone Health Research Group, University of Cambridge, Cambridge, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.,MRC Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Simon M Schoenbuchner
- MRC Biostatistics Unit, University of Cambridge, Cambridge Institute of Public Health, Cambridge, UK
| | - Mustapha Ceesay
- MRC Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Michael Mendy
- MRC Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Landing M Jarjou
- MRC Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Sophie E Moore
- MRC Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia.,Department of Women and Children's Health, King's College London, London, UK
| | - Ann Prentice
- MRC Nutrition and Bone Health Research Group, University of Cambridge, Cambridge, UK.,MRC Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
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Moon RJ, Curtis EM, Woolford SJ, Ashai S, Cooper C, Harvey NC. The importance of maternal pregnancy vitamin D for offspring bone health: learnings from the MAVIDOS trial. Ther Adv Musculoskelet Dis 2021; 13:1759720X211006979. [PMID: 33889216 PMCID: PMC8040612 DOI: 10.1177/1759720x211006979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/12/2021] [Indexed: 12/17/2022] Open
Abstract
Optimisation of skeletal mineralisation in childhood is important to reduce childhood fracture and the long-term risk of osteoporosis and fracture in later life. One approach to achieving this is antenatal vitamin D supplementation. The Maternal Vitamin D Osteoporosis Study is a randomised placebo-controlled trial, the aim of which was to assess the effect of antenatal vitamin D supplementation (1000 IU/day cholecalciferol) on offspring bone mass at birth. The study has since extended the follow up into childhood and diversified to assess demographic, lifestyle and genetic factors that determine the biochemical response to antenatal vitamin D supplementation, and to understand the mechanisms underpinning the effects of vitamin D supplementation on offspring bone development, including epigenetics. The demonstration of positive effects of maternal pregnancy vitamin D supplementation on offspring bone development and the delineation of underlying biological mechanisms inform clinical care and future public-health policies.
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Affiliation(s)
- Rebecca J. Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, UK
| | - Elizabeth M. Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, Hampshire, UK
| | - Stephen J. Woolford
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, Hampshire, UK
| | - Shanze Ashai
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, Hampshire, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, Hampshire, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, Hampshire, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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7
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Wu YF, Lu K, Girgis C, Preda M, Preda V. Postpartum bilateral sacral stress fracture without osteoporosis-a case report and literature review. Osteoporos Int 2021; 32:623-631. [PMID: 33439310 DOI: 10.1007/s00198-020-05788-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Sacral stress fractures are rare complications which can arise during pregnancy or in the early postpartum period. We report a case and discuss the findings of a confirmed postpartum sacral stress fracture in a 39-year-old multiparous woman and review previous case reports in the literature of sacral stress fracture related to pregnancy. METHODS A review of the literature was conducted to examine the main characteristics of sacral stress fractures related to pregnancy. The Ovid/Medline, Embase and Google Scholar databases were searched with the inclusion criteria: human studies, English language, intrapartum, postpartum (within 6 months of parturition), sacrum and stress fracture. Our exclusion criteria included pubic fractures, vertebral fractures and non-English articles. The search terms included "stress fracture", "postpartum", "pregnancy", "atraumatic" and the wildcard "sacr*". Thirty-four cases were found and summarised in Table 2. RESULTS A total of 65% of patients had onset of symptoms postpartum. Most patients did not have risk factors for sacral stress fractures including macrosomia, excessive pregnancy weight gain, heparin exposure, rapid vaginal delivery or predisposition to accelerated osteoporosis. Lumbar radiculopathy can be a feature of sacral stress fracture and it is more common (17.6%) than reported in the literature (2%). MRI is the preferred imaging modality for its safety profile in pregnancy and high sensitivity. A total of 70% reported normal bone mineral density (BMD). The mainstay treatment for sacral stress fractures includes relative bed rest, analgesia and modified weight-bearing exercises. Most patients have favourable outcome with complete symptom resolution. CONCLUSION Sacral stress fractures in the absence of osteoporosis are rare complications of pregnancy that can present with lumbar radiculopathy. Conservative management often produces good clinical outcomes.
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Affiliation(s)
- Y F Wu
- Department of Endocrinology, Macquarie University Hospital, Sydney, NSW, Australia.
| | - K Lu
- Doctors-In-Training, Macquarie University Hospital, Sydney, NSW, Australia
| | - C Girgis
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - M Preda
- I-MED Radiology, Sydney, NSW, Australia
| | - V Preda
- Department of Endocrinology, Macquarie University Hospital, Sydney, NSW, Australia
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Ó Breasail M, Prentice A, Ward K. Pregnancy-Related Bone Mineral and Microarchitecture Changes in Women Aged 30 to 45 Years. J Bone Miner Res 2020; 35:1253-1262. [PMID: 32119748 PMCID: PMC9328654 DOI: 10.1002/jbmr.3998] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/27/2020] [Accepted: 02/13/2020] [Indexed: 12/18/2022]
Abstract
At birth, the neonatal skeleton contains 20 to 30 g calcium (Ca). It is hypothesized maternal bone mineral may be mobilized to support fetal skeletal development, although evidence of pregnancy-induced mineral mobilization is limited. We recruited healthy pregnant (n = 53) and non-pregnant non-lactating (NPNL; n = 37) women aged 30 to 45 years (mean age 35.4 ± 3.8 years) and obtained peripheral quantitative computed tomography (pQCT) and high-resolution pQCT (HR-pQCT) scans from the tibia and radius at 14 to 16 and 34 to 36 weeks of pregnancy, with a similar scan interval for NPNL. Multiple linear regression models were used to assess group differences in change between baseline and follow-up; differences are expressed as standard deviation scores (SDS) ± SEM. Decreases in volumetric bone mineral density (vBMD) outcomes were found in both groups; however, pregnancy-related decreases for pQCT total and trabecular vBMD were -0.65 ± 0.22 SDS and -0.50 ± 0.23 SDS greater (p < .05). HR-pQCT total and cortical vBMD decreased compared with NPNL by -0.49 ± 0.24 SDS and -0.67 ± 0.23 SDS, respectively; trabecular vBMD decreased in both groups to a similar magnitude. Pregnancy-related changes in bone microarchitecture significantly exceeded NPNL change for trabecular number (0.47 ± 0.23 SDS), trabecular separation (-0.54 ± 0.24 SDS), cortical thickness (-1.01 ± 0.21 SDS), and cortical perimeter (0.78 ± 0.23 SDS). At the proximal radius, cortical vBMD and endosteal circumference increased by 0.50 ± 0.23 SDS and 0.46 ± 0.23 SDS, respectively, compared with NPNL, whereas cortical thickness decreased -0.50 ± 0.22 SDS. Pregnancy-related decreases in total and compartment-specific vBMD exceed age-related change at the distal tibia. Changes at the radius were only evident with pQCT at the cortical-rich proximal site and suggest endosteal resorption. Although the magnitude of these pregnancy-related changes in the appendicular skeleton are small, if they reflect global changes across the skeleton at large, they may contribute substantially to the Ca requirements of the fetus. © 2020 Crown copyright. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.
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Affiliation(s)
- Mícheál Ó Breasail
- MRC Nutrition and Bone Health Research Group, University of Cambridge, Cambridge, UK
| | - Ann Prentice
- MRC Nutrition and Bone Health Research Group, University of Cambridge, Cambridge, UK
| | - Kate Ward
- MRC Nutrition and Bone Health Research Group, University of Cambridge, Cambridge, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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Jia P, Wang R, Yuan J, Chen H, Bao L, Feng F, Tang H. A case of pregnancy and lactation-associated osteoporosis and a review of the literature. Arch Osteoporos 2020; 15:94. [PMID: 32583122 DOI: 10.1007/s11657-020-00768-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/04/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The pregnancy and lactation-associated osteoporosis (PLO) is a rare disease whose precise pathophysiological mechanisms remain mostly unknown. CASE REPORT We reported here a case of PLO that occurred in the early postpartum period and led to multiple compression fractures. Combination therapy with alendronate, calcium carbonate, and vitamin D was used to treat the patient and a marked but gradual increase in the density of bone mineral was observed. Moreover, no further fractures have occurred. CONCLUSION PLO is a very rare type of osteoporosis associated with severe chronic back pain. Increased bone resorption significantly increases the risk of bone fractures in women with PLO. Early diagnosis, stopping breastfeeding, treatment of calcium and vitamin D, bisphosphonates, or other antiosteoporosis medicine and regular follow-ups of these cases are particularly important in the prevention of fractures and to increase the quality of life of patients.
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Affiliation(s)
- Pu Jia
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China.
| | - RuiDeng Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China
| | - Jing Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang, Dongcheng District, Beijing, China
| | - Hao Chen
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China
| | - Li Bao
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China
| | - Fei Feng
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China
| | - Hai Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China
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Djukić K, Milovanović P, Milenković P, Djurić M. A microarchitectural assessment of the gluteal tuberosity suggests two possible patterns in entheseal changes. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 172:291-299. [PMID: 32154921 DOI: 10.1002/ajpa.24038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 02/15/2020] [Accepted: 02/21/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Macroscopic entheseal forms show two main features: predominant signs of bony formation or resorption. To understand the development of these forms, we investigated microarchitectural differences between the macroscopic proliferative and resorptive forms of the gluteus maximus enthesis. MATERIALS AND METHODS The macromorphological analysis of entheseal changes (EC) was based on the Villotte, visual scoring system for fibrous entheses. Gluteal tuberosity specimens of different stages of Villote's system were harvested from 16 adult males derived from an archaeological context and scanned using microcomputed tomography. RESULTS The microarchitectural analyzes of cortical bone demonstrated a trend of higher porosity in the resorptive compared to the proliferative phase in Stage B, whereas a 30% porosity reduction was detected in the resorptive compared to proliferative phase of Stage C. In terms of the trabecular bone between the resorptive and proliferative entheseal phases, there was a trend of increased connectivity density, whereas the structural model index decreased in B and increased in C. The assessment of the entire specimen showed an increase in porosity from the proliferative to the resorptive phase in the Stage B, in contrast to a decrease in the Stage C. DISCUSSION The results suggest that from an initial flat entheses, two directions of EC development are possible: (a) a bony prominence may form and, subsequently, it is subjected to trabecularization of the cortical bone inside the prominence, such cortical trabecularization can lead to visible porosity on the cortical external surface; (b) the cortical bone defect may develop with the regular underlying cortical bone.
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Affiliation(s)
- Ksenija Djukić
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Serbia
| | - Petar Milovanović
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Serbia
| | - Petar Milenković
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Serbia.,Institute of Oncology and Radiology of Serbia, National Cancer Research Center, Belgrade, Serbia
| | - Marija Djurić
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Serbia
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Abstract
Vitamin D has important roles in calcium metabolism and in the prevention of rickets and osteomalacia; low levels of 25-hydroxyvitamin D are common in the general population and amongst pregnant women. Whilst there is a wealth of observational evidence linking vitamin D deficiency to a wide range of disease outcomes, there are currently few high-quality randomised controlled trials to confirm any causal associations, although many are currently in progress. Furthermore, currently, the vast majority of published guidelines recommend standard supplemental vitamin D doses for children and pregnant women, yet there is increasing recognition that individual characteristics and genetic factors may influence the response to supplementation. As such, future research needs to concentrate on documenting definite beneficial clinical outcomes of vitamin D supplementation, and establishing personalised dosing schedules and demonstrating effective approaches to optimising initiation and adherence.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- Paediatric Endocrinology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Justin H Davies
- Paediatric Endocrinology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- National Institute for Health Research (NIHR) Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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12
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Savard C, Gagnon C, Morisset AS. Disparities in the timing and measurement methods to assess vitamin D status during pregnancy: A Narrative Review. INT J VITAM NUTR RES 2019; 88:176-189. [PMID: 30747608 DOI: 10.1024/0300-9831/a000507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Studies that examined associations between low circulating 25-hydroxyvitamin D (25(OH)D) and adverse pregnancy outcomes used various designs, assay methods and time points for measurement of 25(OH)D concentrations, which creates some confusion in the current literature. We aimed to investigate the variability in the timing and measurement methods used to evaluate vitamin D status during pregnancy. Analysis of 198 studies published between 1976 and 2017 showed an important variability in the choice of 1) threshold values for 25(OH)D insufficiency or deficiency, 2) 25(OH)D measurement methods, and 3) trimester in which 25(OH)D concentrations were measured. Blood samples were taken once during pregnancy in a large majority of studies, which may not be representative of vitamin D status throughout pregnancy. Most studies reported adjustment for confounding factors including season of blood sampling, but very few studies used the 25(OH)D gold standard assay, the LC-MS/MS. Prospective studies assessing maternal 25(OH)D concentrations 1) by standardized and validated methods, 2) at various time points during pregnancy, and 3) after considering potential confounding factors, are needed.
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Affiliation(s)
- Claudia Savard
- 1 School of Nutrition, Laval University.,2 Endocrinology and Nephrology Unit, CHU of Québec-Université Laval Research Center, Québec, Canada.,3 Institute of Nutrition and Functional Foods, Laval University Quebec City, Québec, Canada
| | - Claudia Gagnon
- 2 Endocrinology and Nephrology Unit, CHU of Québec-Université Laval Research Center, Québec, Canada.,3 Institute of Nutrition and Functional Foods, Laval University Quebec City, Québec, Canada.,4 Department of Medicine, Laval University, Quebec City, Québec, Canada
| | - Anne-Sophie Morisset
- 1 School of Nutrition, Laval University.,2 Endocrinology and Nephrology Unit, CHU of Québec-Université Laval Research Center, Québec, Canada.,3 Institute of Nutrition and Functional Foods, Laval University Quebec City, Québec, Canada
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13
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Curtis EM, Moon RJ, Harvey NC, Cooper C. Maternal vitamin D supplementation during pregnancy. Br Med Bull 2018; 126:57-77. [PMID: 29684104 PMCID: PMC6003599 DOI: 10.1093/bmb/ldy010] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/26/2018] [Indexed: 12/19/2022]
Abstract
Introduction Maternal vitamin D status in pregnancy has been linked to many health outcomes in mother and offspring. A wealth of observational studies have reported on both obstetric outcomes and complications, including pre-eclampsia, gestational diabetes, mode and timing of delivery. Many foetal and childhood outcomes are also linked to vitamin D status, including measures of foetal size, body composition and skeletal mineralization, in addition to later childhood outcomes, such as asthma. Sources of data Synthesis of systematic and narrative reviews. Areas of agreement and controversy The findings are generally inconsistent in most areas, and, at present, there is a lack of data from high-quality intervention studies to confirm a causal role for vitamin D in these outcomes. In most areas, the evidence tends towards maternal vitamin D being of overall benefit, but often does not reach statistical significance in meta-analyses. Growing points and areas timely for developing research The most conclusive evidence is in the role of maternal vitamin D supplementation in the prevention of neonatal hypocalcaemia; as a consequence the UK department of health recommends that pregnant women take 400 IU vitamin D daily. High-quality randomized placebo-controlled trials, such as the UK-based MAVIDOS trial, will inform the potential efficacy and safety of vitamin D supplementation in pregnancy across a variety of outcomes.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
| | - Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
- Paediatric Endocrinology, Southampton University Hospitals NHS
Foundation Trust, Southampton, SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of
Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road,
Southampton, SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of
Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road,
Southampton, SO16 6YD, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford,
Oxford, OX3 7LD, UK
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14
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Munger KL, Hongell K, Åivo J, Soilu-Hänninen M, Surcel HM, Ascherio A. 25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort. Neurology 2017; 89:1578-1583. [PMID: 28904091 DOI: 10.1212/wnl.0000000000004489] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/05/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether and to what extent vitamin D deficiency is associated with multiple sclerosis (MS) risk. METHODS We conducted a prospective nested case-control study among women in the Finnish Maternity Cohort (FMC). The FMC had 1.8 million stored serum samples taken during the pregnancies of over 800,000 women at the time of this study. Through linkages with hospital and prescription registries, we identified 1,092 women with MS diagnosed between 1983 and 2009 with at least 1 serum sample collected prior to date of MS diagnosis; ≥2 serum samples were available for 511 cases. Cases were matched to up to 3 controls (n = 2,123) on date of birth (±2 years) and area of residence. 25-Hydroxyvitamin D (25[OH]D) levels were measured using a chemiluminescence assay. We used conditional logistic regression adjusted for year of sample collection, gravidity, and parity to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS A 50 nmol/L increase in 25(OH)D was associated with a 39% reduced risk of MS (RR 0.61, 95% CI 0.44-0.85), p = 0.003. Women with 25(OH)D levels <30 nmol/L had a 43% higher MS risk (RR 1.43, 95% CI 1.02-1.99, p = 0.04) as compared to women with levels ≥50 nmol/L. In women with ≥2 samples, MS risk was 2-fold higher in women with 25(OH)D <30 nmol/L as compared to women with 25(OH)D ≥50 nmol/L (RR 2.02, 95% CI 1.18-3.45, p = 0.01). CONCLUSIONS These results directly support vitamin D deficiency as a risk factor for MS and strengthen the rationale for broad public health interventions to improve vitamin D levels.
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Affiliation(s)
- Kassandra L Munger
- From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland.
| | - Kira Hongell
- From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland
| | - Julia Åivo
- From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland
| | - Merja Soilu-Hänninen
- From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland
| | - Heljä-Marja Surcel
- From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland
| | - Alberto Ascherio
- From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland
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15
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Souberbielle JC, Brazier F, Piketty ML, Cormier C, Minisola S, Cavalier E. How the reference values for serum parathyroid hormone concentration are (or should be) established? J Endocrinol Invest 2017; 40:241-256. [PMID: 27696297 DOI: 10.1007/s40618-016-0553-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
Well-validated reference values are necessary for a correct interpretation of a serum PTH concentration. Establishing PTH reference values needs recruiting a large reference population. Exclusion criteria for this population can be defined as any situation possibly inducing an increase or a decrease in PTH concentration. As recommended in the recent guidelines on the diagnosis and management of asymptomatic primary hyperparathyroidism, PTH reference values should be established in vitamin D-replete subjects with a normal renal function with possible stratification according to various factors such as age, gender, menopausal status, body mass index, and race. A consensus about analytical/pre-analytical aspects of PTH measurement is also needed with special emphasis on the nature of the sample (plasma or serum), the time and the fasting/non-fasting status of the blood sample. Our opinion is that blood sample for PTH measurement should be obtained in the morning after an overnight fast. Furthermore, despite longer stability of the PTH molecule in EDTA plasma, we prefer serum as it allows to measure calcium, a prerequisite for a correct interpretation of a PTH concentration, on the same sample. Once a consensus is reached, we believe an important international multicentre work should be performed to recruit a very extensive reference population of apparently healthy vitamin D-replete subjects with a normal renal function in order to establish the PTH normative data. Due to the huge inter-method variability in PTH measurement, a sufficient quantity of blood sample should be obtained to allow measurement with as many PTH kits as possible.
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Affiliation(s)
- J-C Souberbielle
- Service des Explorations Fonctionnelles, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France.
- Université René Descartes, 75015, Paris, France.
| | - F Brazier
- Service des Explorations Fonctionnelles, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France
- Université René Descartes, 75015, Paris, France
| | - M-L Piketty
- Service des Explorations Fonctionnelles, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France
- Université René Descartes, 75015, Paris, France
| | - C Cormier
- Rheumatology Department, Cochin University Hospital, 75014, Paris, France
| | - S Minisola
- Ordinario di Medicina Interna, Responsabile UOC Medicina Interna e Malattie Metaboliche dell'Osso (TMC 04), « Sapienza » Università di Roma, Rome, Italy
| | - E Cavalier
- Clinical Chemistry Department, Sart Tilman University Hospital, Liège, Belgium
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16
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Park H, Brannon PM, West AA, Yan J, Jiang X, Perry CA, Malysheva O, Mehta S, Caudill MA. Maternal vitamin D biomarkers are associated with maternal and fetal bone turnover among pregnant women consuming controlled amounts of vitamin D, calcium, and phosphorus. Bone 2017; 95:183-191. [PMID: 27939956 PMCID: PMC5222782 DOI: 10.1016/j.bone.2016.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/18/2016] [Accepted: 12/06/2016] [Indexed: 12/23/2022]
Abstract
Vitamin D plays a central role in calcium homeostasis; however, its relationship with bone turnover during pregnancy remains unclear due to a lack of studies that have rigorously controlled for vitamin D and other nutrients known to influence bone metabolism. Similarly, prior investigations of the effect of pregnancy on bone turnover relative to the nonpregnant state may have been confounded by varying intakes of these nutrients. Nested within a controlled intake study, the present investigation sought to quantify associations between maternal vitamin D biomarkers and biochemical markers of bone turnover among pregnant (versus nonpregnant) women and their fetuses under conditions of equivalent and adequate intakes of vitamin D and related nutrients. Changes in markers of bone turnover across the third trimester were also examined. Healthy pregnant (26-29 wk gestation; n=26) and nonpregnant (n=21) women consumed 511IU vitamin D/d, 1.6g calcium/d, and 1.9g phosphorus/d for 10weeks while participating in a controlled feeding study featuring two choline doses. Based on linear mixed models adjusted for influential covariates (e.g., BMI, ethnicity, and season), pregnant women had 50-150% higher (P<0.001) concentrations of bone resorption markers than nonpregnant women. Among pregnant women, increases in maternal 25(OH)D across the study period were associated (P<0.020) with lower osteocalcin and deoxypyridinoline at study-end, and higher fetal osteocalcin. In addition, maternal free 25(OH)D, 1,25(OH)2D and 24,25(OH)2D tended to be negatively associated (P≤0.063) with maternal NTx at study-end, and maternal free 25(OH)D and 24,25(OH)2D were positively associated (P≤0.021) with fetal CTx. Similarly, maternal 3-epi-25(OH)D3 was negatively related (P≤0.037) to maternal NTx and deoxypyridinoline at study-end. These declines in bone resorption markers resulting from higher vitamin D biomarker concentrations among pregnant women coincided with increases in their albumin-corrected serum calcium concentrations, indicating that calcium transfer to the fetus was uncompromised. Notably, none of these associations achieved statistical significance among nonpregnant women. Overall, our study findings suggest that achieving higher maternal concentrations of vitamin D biomarkers might attenuate third-trimester bone resorption while ensuring sufficient calcium delivery to the fetus.
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Affiliation(s)
- Heyjun Park
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Patsy M Brannon
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Allyson A West
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Jian Yan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Xinyin Jiang
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Cydne A Perry
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Olga Malysheva
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Marie A Caudill
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
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17
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Pregnancy-related osteoporosis and spinal fractures. Obstet Gynecol Sci 2017; 60:133-137. [PMID: 28217686 PMCID: PMC5313358 DOI: 10.5468/ogs.2017.60.1.133] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 11/08/2022] Open
Abstract
Pregnancy-related osteoporosis is a very rare condition characterized by the occurrence of fracture during pregnancy or the puerperium. Despite its relative rarity, it can be a dangerous condition that causes severe back pain, height loss and disability. Normal physiologic changes during pregnancy, genetic or racial difference, obstetrical history and obstetrical disease, such as preterm labor or pregnancy-induced hypertension, are presumed risk factors of pregnancy-related osteooporosis. However, exact etiology and pathogenesis are uncertain. The management and natural history are still poorly defined. Traditional medications for osteoporosis are calcium/vitamin D and bisphosphonate. Concerns with bisphosphonate include accumulation in bone and fetal exposure in subsequent pregnancies. The newly developed medication, teriparatide, has shown good results. We report six cases of pregnancy-related osteoporosis and spinal fracture with literature review.
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18
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Haugen J, Ulak M, Chandyo RK, Henjum S, Thorne-Lyman AL, Ueland PM, Midtun Ø, Shrestha PS, Strand TA. Low Prevalence of Vitamin D Insufficiency among Nepalese Infants Despite High Prevalence of Vitamin D Insufficiency among Their Mothers. Nutrients 2016; 8:nu8120825. [PMID: 28009810 PMCID: PMC5188478 DOI: 10.3390/nu8120825] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/02/2016] [Accepted: 12/07/2016] [Indexed: 12/30/2022] Open
Abstract
Background: Describing vitamin D status and its predictors in various populations is important in order to target public health measures. Objectives: To describe the status and predictors of vitamin D status in healthy Nepalese mothers and infants. Methods: 500 randomly selected Nepalese mother and infant pairs were included in a cross-sectional study. Plasma 25(OH)D concentrations were measured by LC-MS/MS and multiple linear regression analyses were used to identify predictors of vitamin D status. Results: Among the infants, the prevalence of vitamin D insufficiency (25(OH)D <50 nmol/L) and deficiency (<30 nmol/L) were 3.6% and 0.6%, respectively, in contrast to 59.8% and 14.0% among their mothers. Infant 25(OH)D concentrations were negatively associated with infant age and positively associated with maternal vitamin D status and body mass index (BMI), explaining 22% of the variability in 25(OH)D concentration. Global solar radiation, maternal age and BMI predicted maternal 25(OH)D concentration, explaining 9.7% of its variability. Conclusion: Age and maternal vitamin D status are the main predictors of vitamin D status in infants in Bhaktapur, Nepal, who have adequate vitamin D status despite poor vitamin D status in their mothers.
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Affiliation(s)
- Johanne Haugen
- Innlandet Hospital Trust, Lillehammer 2609, Norway.
- Centre for International Health, University of Bergen, Bergen 5007, Norway.
| | - Manjeswori Ulak
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu 8212, Nepal.
| | - Ram K Chandyo
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu 8212, Nepal.
| | - Sigrun Henjum
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo 0130, Norway.
| | - Andrew L Thorne-Lyman
- Johns Hopkins Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- WorldFish, P.O. Box 500 GPO, Penang 10670, Malaysia.
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Per Magne Ueland
- Department of Clinical Science, University of Bergen, Bergen 5007, Norway.
- Bevital AS, Bergen 5021, Norway.
| | - Øivind Midtun
- Department of Clinical Science, University of Bergen, Bergen 5007, Norway.
- Bevital AS, Bergen 5021, Norway.
| | - Prakash S Shrestha
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu 8212, Nepal.
| | - Tor A Strand
- Innlandet Hospital Trust, Lillehammer 2609, Norway.
- Centre for International Health, University of Bergen, Bergen 5007, Norway.
- Department of Sports Science, Inland Norway University of Applied Sciences, Lillehammer 2604, Norway.
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19
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Vitamin D Status during Pregnancy in a Multi-Ethnic Population-Representative Swedish Cohort. Nutrients 2016; 8:nu8100655. [PMID: 27782070 PMCID: PMC5084041 DOI: 10.3390/nu8100655] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/06/2016] [Accepted: 10/14/2016] [Indexed: 12/17/2022] Open
Abstract
There is currently little information on changes in vitamin D status during pregnancy and its predictors. The aim was to study the determinants of change in vitamin D status during pregnancy and of vitamin D deficiency (<30 nmol/L) in early pregnancy. Blood was drawn in the first (T1) and third trimester (T3). Serum 25-hydroxyvitamin D (25(OH)D) (N = 1985) was analysed by liquid chromatography tandem-mass spectrometry. Season-corrected 25(OH)D was calculated by fitting cosine functions to the data. Mean (standard deviation) 25(OH)D was 64.5(24.5) nmol/L at T1 and 74.6(34.4) at T3. Mean age was 31.3(4.9) years, mean body mass index (BMI) was 24.5(4.2) kg/m² and 74% of the women were born in Sweden. Vitamin D deficiency was common among women born in Africa (51%) and Asia (46%) and prevalent in 10% of the whole cohort. Determinants of vitamin D deficiency at T1 were of non-North European origin, and had less sun exposure, lower vitamin D intake and lower age. Season-corrected 25(OH)D increased by 11(23) nmol/L from T1 to T3. The determinants of season-corrected change in 25(OH)D were origin, sun-seeking behaviour, clothing style, dietary vitamin D intake, vitamin D supplementation and recent travel <35° N. In conclusion, season-corrected 25(OH)D concentration increased during pregnancy and depended partly on lifestyle factors. The overall prevalence of vitamin D deficiency was low but common among women born in Africa and Asia. Among them, the determinants of both vitamin D deficiency and change in season-corrected vitamin D status were fewer, indicating a smaller effect of sun exposure.
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20
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Binks MJ, Smith-Vaughan HC, Marsh R, Chang AB, Andrews RM. Cord blood vitamin D and the risk of acute lower respiratory infection in Indigenous infants in the Northern Territory. Med J Aust 2016; 204:238. [PMID: 27031398 DOI: 10.5694/mja15.00798] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/10/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess vitamin D status in Indigenous mothers and infants in the Northern Territory, and to determine whether cord blood vitamin D levels are correlated with the risk of infant hospitalisation for acute lower respiratory infection (ALRI). DESIGN AND PARTICIPANTS Within a nested cohort of 109 Indigenous mother-infant pairs recruited between 2006 and 2011, we used liquid chromatography-mass spectrometry to measure vitamin D (25(OH)D3) levels in maternal blood during pregnancy (n = 33; median gestation, 32 weeks [range, 28-36 weeks]) and at birth (n = 106; median gestation, 39 weeks [range, 34-41 weeks]), in cord blood (n = 84; median gestation, 39 weeks [range, 36-41 weeks]), and in infant blood at age 7 months (n = 37; median age, 7.1 months [range, 6.6-8.1 months]). MAIN OUTCOME MEASURE ALRI hospitalisations during the first 12 months of infancy, identified using International Classification of Diseases coding (J09-J22, A37-A37.9). RESULTS Compared with mean 25(OH)D3 levels in maternal blood during pregnancy (104 nmol/L), mean levels were 23% lower in maternal blood at birth (80 nmol/L) and 48% lower in cord blood samples (54 nmol/L). The mean cord blood 25(OH)D3 concentration in seven infants subsequently hospitalised for an ALRI was 37 nmol/L (95% CI, 25-48 nmol/L), lower than the 56 nmol/L (95% CI, 51-61 nmol/L) in the 77 infants who were not hospitalised with an ALRI (P = 0.025). CONCLUSIONS Cord blood 25(OH)D3 concentrations were about half those in maternal blood during the third trimester of pregnancy (about 7 weeks earlier). Most cord blood levels (80%) were classified as vitamin D insufficient (< 75 nmol/L) by existing guidelines, and were lower among infants who were subsequently hospitalised with an ALRI.
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Affiliation(s)
| | | | - Robyn Marsh
- Menzies School of Health Research, Darwin, NT
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Gulson B, Taylor A, Eisman J. Bone remodeling during pregnancy and post-partum assessed by metal lead levels and isotopic concentrations. Bone 2016; 89:40-51. [PMID: 27233973 DOI: 10.1016/j.bone.2016.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/21/2016] [Accepted: 05/23/2016] [Indexed: 11/16/2022]
Abstract
Bone remodeling is normally evaluated using bone turnover markers/indices as indicators of bone resorption and formation. However, during pregnancy and post-partum, there have been inconsistent results between and within biomarkers for bone formation and resorption. These differences may relate to pregnancy-related changes in metabolism and/or hemodilution altering measured marker levels. An alternative approach to evaluating bone remodeling is to use the metal lead (Pb) concentrations and Pb isotopic compositions in blood. These measurements can also provide information on the amount of Pb that is mobilized from the maternal skeleton. Despite some similarities with accepted bone turnover markers, the Pb data demonstrate increased bone resorption throughout pregnancy that further continues post-partum independent of length of breast-feeding, dietary intake and resumption of menses. Furthermore the isotopic measurements are not affected by hemodilution. These data confirm calcium balance studies that indicate increased bone resorption throughout pregnancy and lactation. They also indicate potentially major public health implications of the transfer of maternal Pb burden to the fetus and new born.
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Affiliation(s)
- Brian Gulson
- Department of Environmental Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia; Commonwealth Scientific and Industrial Research Organisation (CSIRO), Energy Flagship, Sydney, Australia.
| | - Alan Taylor
- Department of Psychology, Macquarie University, Australia.
| | - John Eisman
- Garvan Institute of Medical Research, St Vincent's Hospital, School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia; University of New South Wales, Garvan Institute of Medical Research, St Vincent's Hospital, School of Medicine Sydney, Sydney, NSW, Australia.
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Yeo UH, Choi CJ, Choi WS, Kim KS. Relationship between breast-feeding and bone mineral density among Korean women in the 2010 Korea National Health and Nutrition Examination Survey. J Bone Miner Metab 2016; 34:109-17. [PMID: 25792237 DOI: 10.1007/s00774-015-0649-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/25/2014] [Indexed: 11/25/2022]
Abstract
Breast-feeding has the deleterious effect of hypoestrogenemia coupled with loss of calcium in the maternal bone mass. It is not clear whether changes in bone metabolism in lactating women lead to changes in maternal bone mineral density (BMD) over a longer period. The aim of the present study was to investigate the relationship between the duration of breast-feeding and BMD in healthy South Korean women. We analyzed data from the 2010 Korea National Health and Nutrition Examination Survey, a cross-sectional survey of Korean citizens. A total of 1342 women older than 19 years were selected for analysis. In postmenopausal women, the duration of breast-feeding per child was associated with low lumbar spine BMD after adjustment for age, body mass index, smoking, alcohol intake, physical activity, serum 25-hydroxyvitamin D level, and daily intake of calcium and calories (P < 0.05, P trend < 0.005). Prolonged breast-feeding for more than 1 year per child was associated with a deleterious effect on lumbar spine BMD compared with never breast-feeding or a shorter duration of breast-feeding (P < 0.05). These effects were not shown in premenopausal women or in femur BMD. In conclusion, the duration of breast-feeding per child is negatively correlated with lumbar spine BMD in postmenopausal women, but not in premenopausal women. Although the cause of the different results between postmenopausal and premenopausal women is not clear, our findings suggest that proper protective strategies should be recommended during prolonged breast-feeding to maintain bone health later in life.
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Affiliation(s)
- Ui Hyang Yeo
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea
| | - Chang Jin Choi
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea.
| | - Whan Seok Choi
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea
| | - Kyung Soo Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea
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Moon RJ, Crozier SR, Dennison EM, Davies JH, Robinson SM, Inskip HM, Godfrey KM, Cooper C, Harvey NC. Tracking of 25-hydroxyvitamin D status during pregnancy: the importance of vitamin D supplementation. Am J Clin Nutr 2015; 102:1081-7. [PMID: 26399867 PMCID: PMC4634223 DOI: 10.3945/ajcn.115.115295] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/26/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The role of maternal 25-hydroxyvitamin D [25(OH)D] in fetal development is uncertain, and findings of observational studies have been inconsistent. Most studies have assessed 25(OH)D only one time during pregnancy, but to our knowledge, the tracking of an individual's 25(OH)D during pregnancy has not been assessed previously. OBJECTIVE We determined the tracking of serum 25(OH)D from early to late pregnancy and factors that influence this. DESIGN The Southampton Women's Survey is a prospective mother-offspring birth-cohort study. Lifestyle, diet, and 25(OH)D status were assessed at 11 and 34 wk of gestation. A Fourier transformation was used to model the seasonal variation in 25(OH)D for early and late pregnancy separately, and the difference between the measured and seasonally modeled 25(OH)D was calculated to generate a season-corrected 25(OH)D. Tracking was assessed with the use of the Pearson correlation coefficient, and multivariate linear regression was used to determine factors associated with the change in season-corrected 25(OH)D. RESULTS A total of 1753 women had 25(OH)D measured in both early and late pregnancy. There was a moderate correlation between season-corrected 25(OH)D measurements at 11 and 34 wk of gestation (r = 0.53, P < 0.0001; n = 1753). Vitamin D supplementation was the strongest predictor of tracking; in comparison with women who never used supplements, the discontinuation of supplementation after 11 wk was associated with a reduction in season-corrected 25(OH)D (β = -7.3 nmol/L; P < 0.001), whereas the commencement (β = 12.6 nmol/L; P < 0.001) or continuation (β = 6.6 nmol/L; P < 0.001) of supplementation was associated with increases in season-corrected 25(OH)D. Higher pregnancy weight gain was associated with a reduction in season-corrected 25(OH)D (β = -0.4 nmol · L(-1) · kg(-1); P = 0.015), whereas greater physical activity (β = 0.4 nmol/L per h/wk; P = 0.011) was associated with increases. CONCLUSIONS There is a moderate tracking of 25(OH)D status through pregnancy; factors such as vitamin D supplementation, weight gain, and physical activity are associated with changes in season-corrected 25(OH)D from early to late gestation. These findings have implications for study designs and analyses and approaches to intervention studies and clinical care.
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Affiliation(s)
- Rebecca J Moon
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom; Paediatric Endocrinology, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | - Sarah R Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Elaine M Dennison
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Justin H Davies
- Paediatric Endocrinology, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | - Sian M Robinson
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Hazel M Inskip
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom; National Institute for Health Research (NIHR) Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; and
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom; National Institute for Health Research (NIHR) Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; and
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom; National Institute for Health Research (NIHR) Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; and
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24
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Moon RJ, Harvey NC, Cooper C. ENDOCRINOLOGY IN PREGNANCY: Influence of maternal vitamin D status on obstetric outcomes and the fetal skeleton. Eur J Endocrinol 2015; 173:R69-83. [PMID: 25862787 PMCID: PMC4968635 DOI: 10.1530/eje-14-0826] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/10/2015] [Indexed: 12/28/2022]
Abstract
Vitamin D status has been increasingly associated with wide-ranging clinical outcomes. There is now a wealth of observational studies reporting on its associations with obstetric complications, including pre-eclampsia, gestational diabetes and the mode and timing of delivery. The findings are inconsistent, and currently there is a lack of data from high-quality intervention studies to confirm a causal role for vitamin D in these outcomes. This is similarly true with regards to fetal development, including measures of fetal size and skeletal mineralisation. Overall, there is an indication of possible benefits of vitamin D supplementation during pregnancy for offspring birthweight, calcium concentrations and bone mass as well as for reduced maternal pre-eclampsia. However, for none of these outcomes is the current evidence base conclusive, and the available data justify the instatement of high-quality randomised placebo controlled trials in a range of populations and health care settings to establish the potential efficacy and safety of vitamin D supplementation to improve particular outcomes.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
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25
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Sanz-Salvador L, García-Pérez MÁ, Tarín JJ, Cano A. Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture. Eur J Endocrinol 2015; 172:R53-65. [PMID: 25209679 DOI: 10.1530/eje-14-0424] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Changes in bone density and bone markers suggest that pregnancy is associated with deterioration of bone mass in the mother. The metabolism of calcium resets to allow for the needs imposed by the building of the fetal skeleton. The fetus contributes to the process through the output of regulators from the placenta. Understanding of the whole process is limited, but some changes are unambiguous. There is an increase in the circulating levels of vitamin D, but its functional impact is unclear. Fetal parathyroid hormone (PTH) and PTH-related peptide (PTHrp) play an indirect role through support of a calcium gradient that creates hypercalcemia in the fetus. Placental GH, which increases up to the end of pregnancy, may exert some anabolic effects, either directly or through the regulation of the IGF1 production. Other key regulators of bone metabolism, such as estrogens or prolactin, are elevated during pregnancy, but their role is uncertain. An increase in the ratio of receptor activator of nuclear factor kappa B ligand (RANKL) to osteoprotegerin (OPG) acts as an additional pro-resorbing factor in bone. The increase in bone resorption may lead to osteoporosis and fragility fracture, which have been diagnosed, although rarely. However, the condition is transitory as long-term studies do not link the number of pregnancies with osteoporosis. Prevention is limited by the lack of identifiable risk factors. When fractures are diagnosed, rest, analgesics, or, when indicated, orthopedic intervention have demonstrated efficacy. Systemic treatment with anti-osteoporotic drugs is effective, but the potential harm to the fetus imposes caution in their use.
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Affiliation(s)
- Lucía Sanz-Salvador
- Fundación para la Investigación Sanitaria y Biomédica (FISABIO)Juan de Garay 21, 46017 Valencia, SpainDepartment of GeneticsUniversity of Valencia and Research Foundation, INCLIVA, Avenida Blasco Ibáñez 15, 46010 Valencia, SpainDepartment of Functional Biology and Physical AnthropologySchool of Biological Sciences, University of Valencia, Burjasot Campus, Valencia, SpainDepartment of PediatricsObstetrics and Gynecology, Facultad de Medicina, University Hospital Dr Peset, University of Valencia, Avenida Blasco Ibáñez 15, 46010 Valencia, Spain
| | - Miguel Ángel García-Pérez
- Fundación para la Investigación Sanitaria y Biomédica (FISABIO)Juan de Garay 21, 46017 Valencia, SpainDepartment of GeneticsUniversity of Valencia and Research Foundation, INCLIVA, Avenida Blasco Ibáñez 15, 46010 Valencia, SpainDepartment of Functional Biology and Physical AnthropologySchool of Biological Sciences, University of Valencia, Burjasot Campus, Valencia, SpainDepartment of PediatricsObstetrics and Gynecology, Facultad de Medicina, University Hospital Dr Peset, University of Valencia, Avenida Blasco Ibáñez 15, 46010 Valencia, Spain
| | - Juan J Tarín
- Fundación para la Investigación Sanitaria y Biomédica (FISABIO)Juan de Garay 21, 46017 Valencia, SpainDepartment of GeneticsUniversity of Valencia and Research Foundation, INCLIVA, Avenida Blasco Ibáñez 15, 46010 Valencia, SpainDepartment of Functional Biology and Physical AnthropologySchool of Biological Sciences, University of Valencia, Burjasot Campus, Valencia, SpainDepartment of PediatricsObstetrics and Gynecology, Facultad de Medicina, University Hospital Dr Peset, University of Valencia, Avenida Blasco Ibáñez 15, 46010 Valencia, Spain
| | - Antonio Cano
- Fundación para la Investigación Sanitaria y Biomédica (FISABIO)Juan de Garay 21, 46017 Valencia, SpainDepartment of GeneticsUniversity of Valencia and Research Foundation, INCLIVA, Avenida Blasco Ibáñez 15, 46010 Valencia, SpainDepartment of Functional Biology and Physical AnthropologySchool of Biological Sciences, University of Valencia, Burjasot Campus, Valencia, SpainDepartment of PediatricsObstetrics and Gynecology, Facultad de Medicina, University Hospital Dr Peset, University of Valencia, Avenida Blasco Ibáñez 15, 46010 Valencia, Spain
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Djukic K, Milovanovic P, Hahn M, Busse B, Amling M, Djuric M. Bone microarchitecture at muscle attachment sites: The relationship between macroscopic scores of entheses and their cortical and trabecular microstructural design. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2014; 157:81-93. [DOI: 10.1002/ajpa.22691] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Ksenija Djukic
- Laboratory for Anthropology; Institute of Anatomy; Faculty of Medicine University of Belgrade; Belgrade Serbia
| | - Petar Milovanovic
- Laboratory for Anthropology; Institute of Anatomy; Faculty of Medicine University of Belgrade; Belgrade Serbia
| | - Michael Hahn
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Björn Busse
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Michael Amling
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Marija Djuric
- Laboratory for Anthropology; Institute of Anatomy; Faculty of Medicine University of Belgrade; Belgrade Serbia
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27
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Abstract
Nutritional requirements for vitamin D during pregnancy have been inadequately described, and there are conflicting data on the impact of gestation on vitamin D status. In the present study, we conducted a longitudinal analysis of total and free (unbound) serum 25-hydroxyvitamin D (25(OH)D), vitamin D-binding protein (DBP) and albumin concentrations in a random sample of thirty women from the Screening for Pregnancy Endpoints Ireland pregnancy cohort study at 15, 20, 24, 28, 32, 36 and 40 weeks of gestation and at 2 months postpartum. Concentrations of serum 25(OH)D, DBP and albumin were determined, and free 25(OH)D was calculated from the concentrations of total 25(OH)D, DBP and albumin. Serum albumin concentration decreased during pregnancy (P< 0·001), with a nadir at 36 weeks (P< 0·005), during which the concentration was approximately 80 % of the postnatal concentration. Serum DBP concentration increased during pregnancy and at 28 weeks of gestation, which was almost double the postnatal level (P< 0·001). Total and free 25(OH)D concentrations decreased (bothP< 0·005) as pregnancy progressed, and both were lowest at 36 weeks of gestation. At 15 weeks, 10 and 63 % of the women had serum 25(OH)D concentration < 30 and 50 nmol/l, respectively, which increased to 53 and 80 % at 36 weeks of gestation. The time course of decreasing concentrations of 25(OH)D during gestation among women recruited during May–July, who delivered between October and November, and among those recruited in August–September, who delivered between February and March, was similar. The lower percentage of free 25(OH)D during pregnancy is mainly due to increased DBP.
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28
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Canal-Macias ML, Roncero-Martin R, Moran JM, Lavado-Garcia JM, Costa-Fernandez MDC, Pedrera-Zamorano JD. Increased bone mineral density is associated with breastfeeding history in premenopausal Spanish women. Arch Med Sci 2013; 9:703-8. [PMID: 24049532 PMCID: PMC3776181 DOI: 10.5114/aoms.2013.36903] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 09/19/2012] [Accepted: 11/29/2012] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION During lactation abundant calcium is lost from the mother as a result of the amount of breast milk produced. Lactation leads to transient fragility, with some women experiencing even fragility fractures, but nearly all of these women subsequently undergo a large increase in bone mineral density (BMD), confirming that the BMD must have declined during lactation but it increases after weaning. We have retrospectively examined the relationship between the duration of breastfeeding and bone properties in Spanish premenopausal healthy women, to identify the site-specific changes in BMD. MATERIAL AND METHODS Four hundred and thirty-three premenopausal healthy women, 295 with a mean of 7.82 ±6.68 months of exclusive breastfeeding and 138 control women, were studied. We examined total, trabecular and cortical volumetric BMD (mg/mm(3)) at the distal radius using peripheral quantitative computed tomography. Areal BMD (g/cm(2)) was measured using dual energy X-ray absorptiometry at the femoral neck, lumbar spine, trochanter and Ward's triangle. Phalangeal bone ultrasound was measured by amplitude-dependent speed of sound. RESULTS Areal BMD analysis at L2-L4 revealed significant intergroup differences (p < 0.05). There were significant intergroup differences in the volumetric BMD in both total and cortical bone (p < 0.05). The observed BMD of breast-feeders was higher than the BMD in non-breast-feeding women. Additionally, the lactation subgroup analysis revealed significant differences in the areal BMD at trochanter and L2-L4 (p < 0.05) and in the cortical volumetric BMD (p < 0.05). CONCLUSIONS This study adds to the growing evidence that breastfeeding has no deleterious effects and may confer an additional advantage for BMD in premenopausal women.
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Affiliation(s)
- Maria Luz Canal-Macias
- Metabolic Bone Diseases Research Group (GIEMO), University of Extremadura, School of Nursing and Occupational Therapy, Cáceres, Spain
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29
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Møller UK, Streym S, Mosekilde L, Heickendorff L, Flyvbjerg A, Frystyk J, Jensen LT, Rejnmark L. Changes in calcitropic hormones, bone markers and insulin-like growth factor I (IGF-I) during pregnancy and postpartum: a controlled cohort study. Osteoporos Int 2013; 24:1307-20. [PMID: 22855199 DOI: 10.1007/s00198-012-2062-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 06/18/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Pregnancy and lactation cause major changes in calcium homeostasis and bone metabolism. This population-based cohort study presents the physiological changes in biochemical indices of calcium homeostasis and bone metabolism during pregnancy and lactation INTRODUCTION We describe physiological changes in calcium homeostasis, calcitropic hormones and bone metabolism during pregnancy and lactation. METHODS We studied 153 women planning pregnancy (n=92 conceived) and 52 non-pregnant, age-matched female controls. Samples were collected prior to pregnancy, once each trimester and 2, 16 and 36 weeks postpartum. The controls were followed in parallel. RESULTS P-estradiol (E2), prolactin and 1,25-dihydroxyvitamin D (1,25(OH)2D) increased (p<0.001) during pregnancy, whereas plasma levels of parathyroid hormone (P-PTH) and calcitonin decreased (p<0.01). Insulin-like growth factor I (IGF-I) was suppressed (p<0.05) in early pregnancy but peaked in the third trimester. Postpartum, E2 was low (p<0.05); prolactin decreased according to lactation status (p<0.05). 1,25(OH)2D was normal and IGF-I was again reduced (p<0.05). P-PTH and calcitonin increased postpartum. From early pregnancy, markers of bone resorption and formation rose and fall, respectively (p<0.001). From the third trimester, bone formation markers increased in association with IGF-I changes (p<0.01). Postpartum increases in bone turnover markers were associated with lactation status (p<0.001). During lactation, plasma phosphate was increased, whereas calcium levels tended to be decreased which may stimulate PTH levels during and after prolonged lactation. CONCLUSION The increased calcium requirements in early pregnancy are not completely offset by increased intestinal calcium absorption caused by high 1,25(OH)2D since changes in bone markers indicated a negative bone balance. The rise in bone formation in late pregnancy may be initiated by a spike in IGF-I levels. The high bone turnover in lactating women may be related to high prolactin and PTH levels, low E2 levels and perhaps increased parathyroid hormone-related protein levels.
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Affiliation(s)
- U K Møller
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Tage Hansens Gade 2, 8000, Aarhus C, Denmark.
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30
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Abstract
Pregnancy and lactation are times of additional demand for Ca. Ca is transferred across the placenta for fetal skeletal mineralisation, and supplied to the mammary gland for secretion into breast milk. In theory, these additional maternal requirements could be met through mobilisation of Ca from the skeleton, increased intestinal Ca absorption efficiency, enhanced renal Ca retention or greater dietary Ca intake. The extent to which any or all of these apply, the underpinning biological mechanisms and the possible consequences for maternal and infant bone health in the short and long term are the focus of the present review. The complexities in the methodological aspects of interpreting the literature in this area are highlighted and the inter-individual variation in the response to pregnancy and lactation is reviewed. In summary, human pregnancy and lactation are associated with changes in Ca and bone metabolism that support the transfer of Ca between mother and child. The changes generally appear to be independent of maternal Ca supply in populations where Ca intakes are close to current recommendations. Evidence suggests that the processes are physiological in humans and that they provide sufficient Ca for fetal growth and breast-milk production, without relying on an increase in dietary Ca intake or compromising long-term maternal bone health. Further research is needed to determine the limitations of the maternal response to the Ca demands of pregnancy and lactation, especially among mothers with marginal and low dietary Ca intake, and to define vitamin D adequacy for reproductive women.
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31
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Abstract
Concerns exist about the adequacy of vitamin D in pregnant and lactating women. This review assesses the evidence that maternal vitamin D status influences maternal, fetal, and breast-fed infant bone health; maternal adverse outcomes (preeclampsia, gestational diabetes, obstructed labor, and infectious disease); fetal adverse outcomes (growth, gestational age, and developmental programming); and infant adverse outcomes. The evidence for all of these outcomes is contradictory (except for maternal infectious disease) and lacking causality; thus, it is inconclusive. The 2011 Dietary Reference Intakes for vitamin D and their implications for assessing vitamin D status are discussed. An estimated 5% to 29% of American pregnant women may have inadequate vitamin D status, with the higher prevalence in African Americans. Little is known about the prevalence of inadequacy in American lactating women. Research needs are also identified, especially the need for rigorous and well-designed randomized clinical trials to determine the role of vitamin D in nonbone health outcomes in pregnancy and lactation.
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Affiliation(s)
- Patsy M Brannon
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
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Horwitz MJ, Tedesco MB, Sereika SM, Prebehala L, Gundberg CM, Hollis BW, Bisello A, Garcia-Ocaña A, Carneiro RM, Stewart AF. A 7-day continuous infusion of PTH or PTHrP suppresses bone formation and uncouples bone turnover. J Bone Miner Res 2011; 26:2287-97. [PMID: 21544866 PMCID: PMC3304443 DOI: 10.1002/jbmr.415] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Human in vivo models of primary hyperparathyroidism (HPT), humoral hypercalcemia of malignancy (HHM), or lactational bone mobilization for more than 48 hours have not been described previously. We therefore developed 7-day continuous-infusion models using human parathyroid hormone(1-34) [hPTH(1-34)] and human parathyroid hormone-related protein(1-36) [hPTHrP(1-36)] in healthy human adult volunteers. Study subjects developed sustained mild increases in serum calcium (10.0 mg/dL), with marked suppression of endogenous PTH(1-84). The maximal tolerated infused doses over a 7-day period (2 and 4 pmol/kg/h for PTH and PTHrP, respectively) were far lower than in prior, briefer human studies (8 to 28 pmol/kg/h). In contrast to prior reports using higher PTH and PTHrP doses, both 1,25-dihydroxyvitamin D(3) [1,25(OH)(2) D(3) ] and tubular maximum for phosphorus (TmP/GFR) remained unaltered with these low doses despite achievement of hypercalcemia and hypercalciuria. As expected, bone resorption increased rapidly and reversed promptly with cessation of the infusion. However, in contrast to events in primary HPT, bone formation was suppressed by 30% to 40% for the 7 days of the infusions. With cessation of PTH and PTHrP infusion, bone-formation markers abruptly rebounded upward, confirming that bone formation is suppressed by continuous PTH or PTHrP infusion. These studies demonstrate that continuous exposure of the human skeleton to PTH or PTHrP in vivo recruits and activates the bone-resorption program but causes sustained arrest in the osteoblast maturation program. These events would most closely mimic and model events in HHM. Although not a perfect model for lactation, the increase in resorption and the rebound increase in formation with cessation of the infusions are reminiscent of the maternal skeletal calcium mobilization and reversal that occur following lactation. The findings also highlight similarities and differences between the model and HPT.
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Affiliation(s)
- Mara J. Horwitz
- The Division of Endocrinology, The University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Mary Beth Tedesco
- The Division of Endocrinology, The University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Susan M. Sereika
- The University of Pittsburgh School of Nursing and The Graduate School of Public Health, Pittsburgh PA
| | - Linda Prebehala
- The Division of Endocrinology, The University of Pittsburgh School of Medicine, Pittsburgh PA
| | | | | | - Alessandro Bisello
- The Division of Endocrinology, The University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Adolfo Garcia-Ocaña
- The Division of Endocrinology, The University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Raquel M. Carneiro
- The Division of Endocrinology, The University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Andrew F. Stewart
- The Division of Endocrinology, The University of Pittsburgh School of Medicine, Pittsburgh PA
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Liu J, Yang H, Shi H, Shen C, Zhou W, Dai Q, Jiang Y. Blood copper, zinc, calcium, and magnesium levels during different duration of pregnancy in Chinese. Biol Trace Elem Res 2010; 135:31-7. [PMID: 19669713 DOI: 10.1007/s12011-009-8482-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022]
Abstract
Concentrations of various trace elements are altered during pregnancy with changes in the mother's physiology and the requirements of growing fetus. The aim of the present longitudinal study was to learn the changes of trace element copper (Cu), zinc (Zn), calcium (Ca), and magnesium (Mg) of normal pregnant woman during different durations of pregnancy and establish the reference values of changes of statistical significance. Blood samples were obtained from 128 normal pregnant women during early (10-14th week), mid (20-24th week), and late (30-34th week) pregnancy and 6-12th week postpartum and 120 healthy unpregnant healthy women. The full blood concentrations of chosen elements were measured by means of an atomic absorption spectrophotometer. Changes on levels of Cu, Ca, and Mg during all the three durations of pregnancy and Zn during mid and late pregnancy and postpartum were of statistical significance and new reference values of them were set in the present study. These new reference values will be helpful in assessing the health status of pregnant women with a socioeconomic and racial background similar to those of our study participants and give treatments to them promptly.
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Affiliation(s)
- Jinhao Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, No 20, Section 3, Ren Min Nan Lu, Chengdu, Sichuan 610041, People's Republic of China
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Maghbooli Z, Hossein-Nezhad A, Nikoo MK, Shafei AR, Rahmani M, Larijani B. Bone marker status in mothers and their newborns in Iran. J Matern Fetal Neonatal Med 2009; 20:639-43. [PMID: 17701663 DOI: 10.1080/14767050701483470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The contribution of maternal skeletal calcium metabolism in pregnancy is evidenced in changes in the markers of bone formation and bone resorption. Changes in maternal bone markers could affect fetal bone mineralization. The aim of this study was to determine the association between maternal and cord blood bone markers. METHODS Five hundred and fifty-two pregnant women were recruited from Tehran University educating hospitals in the winter of 2002. Maternal and cord blood samples were taken at delivery. The serum was assayed for osteocalcin and crosslaps, calcium, and parathyroid hormone. RESULTS There was significant correlation between maternal and cord blood serum osteocalcin and crosslaps levels, and the mean cord blood levels of osteocalcin and crosslaps were significantly higher at about 1.59- and 1.62-fold maternal levels, respectively. Serum calcium levels strongly correlated with osteocalcin and crosslaps in mothers (r = 0.21, p = 0.001 and r = 0.25, p = 0.001, respectively). CONCLUSIONS Skeletal calcium release may play a major role in calcium homeostasis during pregnancy. Because of this, calcium supplements could have an important role in pregnant women in decreasing the risk of subsequent complications such as osteoporosis.
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Affiliation(s)
- Zhila Maghbooli
- Endocrinology and Metabolism Research Center, Medical Sciences, University of Tehran, Tehran, Iran
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35
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Carroll MA, Vidaeff AC, Mele L, Wapner RJ, Mercer B, Peaceman AM, Sorokin Y, Dudley DJ, Spong CY, Leveno KJ, Harper M, Caritis SN, Miodovnik M, Thorp JM, Moawad A, O'Sullivan MJ, Carpenter MW, Rouse DJ, Sibai B. Bone metabolism in pregnant women exposed to single compared with multiple courses of corticosteroids. Obstet Gynecol 2008; 111:1352-8. [PMID: 18515519 PMCID: PMC2810116 DOI: 10.1097/aog.0b013e318173573b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare markers of maternal bone metabolism between women who received a single compared with multiple courses of antenatal corticosteroids. METHODS This is an analysis of serum samples from a previously reported randomized, placebo-controlled, multicenter trial. Women at risk for preterm delivery after an initial course of corticosteroids were randomly assigned to weekly courses of betamethasone (active) or placebo. Serum levels of carboxy terminal propeptide of type I procollagen (PICP) and cross-linked carboxy terminal telopeptide of type I collagen (ICTP) were measured to assess the rate of bone formation and resorption, respectively, at three time points. The placebo group (n=93) was compared with the active group, receiving four or more courses of betamethasone (n=112). RESULTS There were significant (P<.001) increases in PICP and ICTP between baseline and delivery in both groups. Cross-linked carboxy terminal telopeptide of type I collagen, but not PICP, was lower with corticosteroid exposure immediately before administration of the fourth study course (P<.001). No significant differences in PICP and ICTP were seen between groups at delivery. CONCLUSION Increasing levels of PICP and ICTP with advancing gestation are consistent with physiologic changes in maternal bone metabolism. Multiple courses of corticosteroids for fetal maturation are not associated with persistent or cumulative effects on maternal bone metabolism as measured by PICP and ICTP. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Mary A Carroll
- Department of Obstetrics and Gynecology, University of Texas Houston, Houston, Texas 77030, USA
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Briana DD, Gourgiotis D, Boutsikou M, Baka S, Hassiakos D, Vraila VM, Creatsas G, Malamitsi-Puchner A. Perinatal bone turnover in term pregnancies: the influence of intrauterine growth restriction. Bone 2008; 42:307-13. [PMID: 18024242 DOI: 10.1016/j.bone.2007.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 09/05/2007] [Accepted: 10/03/2007] [Indexed: 10/22/2022]
Abstract
Intrauterine growth restriction (IUGR) has been associated with low bone mass in infancy and increased risk for osteoporosis development in adult life. We aimed to investigate the effect of IUGR on bone metabolism in mother/infant pairs, by determining circulating biochemical markers of bone turnover in IUGR and appropriate for gestational age (AGA) pregnancies. Circulating markers of bone formation [bone specific alkaline phosphatase (BALP), total alkaline phosphatase (ALP), osteocalcin (OC)] and bone resorption [cross-linked N-telopeptide of type I collagen (NTx)], as well as intact parathormone (PTH), calcium and phosphorus levels were measured in 40 mothers and their 20 IUGR and 20 AGA singleton full-term fetuses and neonates on postnatal days 1 (N1) and 4 (N4). No significant differences in BALP, ALP, OC, NTx, PTH, calcium or phosphorus levels were observed between the AGA and the IUGR groups. In both groups, maternal BALP levels were lower compared to fetal, N1 and N4 levels (p< or =0.005 in all cases). In the AGA group, maternal NTx and OC levels were lower compared to fetal, N1 and N4 levels (p<0.001 in all cases), and fetal NTx levels were lower compared to N1 and N4 ones (p<0.001 and p=0.002, respectively). In the IUGR group, maternal OC levels were lower compared to fetal, N1 and N4 ones (p<0.001 in each case) and fetal OC levels were elevated compared to N1 and N4 ones (p<0.001 and p=0.003, respectively). N4 NTx levels were elevated compared to maternal, fetal and N1 levels (p=0.009, p<0.001 and p=0.002, respectively) and fetal NTx levels were lower compared to N1 and N4 ones (p=0.001 and p<0.001, respectively). Finally, positive correlations were found between maternal NTx and BALP (r=0.332, p=0.037), as well as ALP (r=0.329, p=0.038) levels, and between maternal, fetal, N1, N4 BALP and respective ALP levels (r=0.432, p=0.005, r=0.534, p=0.001, r=0.778, p<0.001, r=0.694, p<0.001, respectively). In conclusion, maternal, fetal and neonatal bone turnover in IUGR cases may not differ from respective bone metabolism in AGA controls. In addition, fetal and neonatal bone remodeling is markedly enhanced and independent of maternal bone turnover in late pregnancy.
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Affiliation(s)
- Despina D Briana
- Second Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece
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37
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Shoji K, Ohtsuka-Isoya M, Shimauchi H, Shinoda H. Effects of lactation on alveolar bone loss in experimental periodontitis. J Periodontol 2007; 78:152-6. [PMID: 17199552 DOI: 10.1902/jop.2007.060037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The development and progression of periodontitis are accelerated by various systemic conditions. The present study was designed to determine whether lactation affects alveolar bone loss in rat models of experimental periodontitis. METHODS Sixty-two female Wistar rats were bred with male rats and divided into three groups that were fed diets containing 0.9%, 0.3%, and 0.02% calcium. They were divided further into two subgroups of lactating and non-lactating animals. An elastic ring was placed around the neck of the right mandibular first molar to induce periodontitis (experimental side) on day 32 after mating. The left first molar was not fitted with an elastic ring (control side). After the lactation period, bone mineral density (BMD) was determined, and a histologic examination of the interdental alveolar bone was performed. RESULTS On the experimental and control sides, BMD decreased significantly according to the amount of calcium in the diet; however, the magnitude of this decrease was much greater in the lactating group. Histologic examination revealed that in lactating and non-lactating rats, the decrease in BMD was accompanied by a decrease in alveolar bone height on the experimental side, whereas similar results were not seen on the control side. CONCLUSIONS Lactation could be a risk factor for alveolar bone loss, especially under conditions of calcium insufficiency. Increased systemic demand for calcium and an insufficient supply of calcium might enhance the development of alveolar bone loss in periodontitis.
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Affiliation(s)
- Kanako Shoji
- Division of Periodontology and Endodontology, Department of Oral Biology, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Abstract
Vitamin D is a secosteroid with an endocrine mechanism of action which is sequentially synthesized in humans in the skin, liver and kidneys. The active hormone, 1alpha,25-dihydrocholecalciferol [1,25(OH)2D3], is often considered only in terms of its role in controlling calcium and phosphorus homeostasis. However, cumulative evidence points to the presence of vitamin D receptors in many tissues. The present article summarizes key points regarding the participation of vitamin D in pregnancy and breastfeeding. During pregnancy, sufficient vitamin D concentrations are needed not only to address the growing demand for calcium on the part of the fetus, but also to participate in fetal growth, development of the nervous system, lung maturation and fetal immune system function. Hypovitaminosis D has been related to the development of diabetes, pre-eclampsia and fetal neurological disorders. During pregnancy and lactation, calcium from the maternal skeleton is mobilized, with a rise in bone turnover and a reduction in bone mass. It is advisable for pregnant and nursing women to maintain adequate levels of vitamin D, through small doses of solar exposure to facilitate natural formation of the hormone or by ingesting appropriate vitamin supplements. Further studies are needed to clarify the many gaps in knowledge and elucidate the role of vitamin D in the context of reproduction. Confirmation of experimental observations relating to the risks of hypovitaminosis D would have important public health implications.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynecology, Zaragoza Gynecological Institute, Zaragoza, Spain.
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Patano N, Marinaccio M, Vimercati A, Camerino C, Mancini L, Selvaggi L, Zallone A. Enhanced osteoclastogenesis in women after natural delivery. Biochem Biophys Res Commun 2005; 334:487-90. [PMID: 16005853 DOI: 10.1016/j.bbrc.2005.06.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Accepted: 06/20/2005] [Indexed: 11/15/2022]
Abstract
In the pre-expulsive and expulsive phases of labor, oxytocin and several other osteoclastogenic mediators, such as prostaglandins and IL-6, are secreted in high concentrations. This study was undertaken to assess whether the peripheral blood obtained from healthy women after vaginal delivery contains a larger pool of osteoclast precursors compared with age- and gender-matched controls. Our results clearly show that the number and size of osteoclasts generated in vitro from osteoclast precursors isolated from women after delivery are significantly larger than those from controls. This finding can account for the decrease in bone mass that is often observed during the breastfeeding period and the concomitant release of high quantities of calcium in the milk. Further investigations are required to establish whether analysis of blood osteoclast precursors can be predictive of changes in bone remodeling in this setting.
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Affiliation(s)
- Nicola Patano
- Department of Human Anatomy and Histology, University of Bari, Italy
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40
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HONG JOONSEOK, SANTOLAYA-FORGAS JOAQUIN, ROMERO ROBERTO, ESPINOZA JIMMY, GONÇALVES LUÍSF, KIM YEONMEE, EDWIN SAMUEL, YOON BOHYUN, NIEN JYHKAE, HASSAN SONIA, MAZOR MOSHE. Maternal plasma osteoprotegerin concentration in normal pregnancy. Am J Obstet Gynecol 2005; 193:1011-5. [PMID: 16157103 PMCID: PMC1351230 DOI: 10.1016/j.ajog.2005.06.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 05/03/2005] [Accepted: 06/13/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Pregnancy is associated with major changes in calcium metabolism because the neonatal skeleton contains approximately 30 g of calcium, which are largely deposited in the third trimester. Osteoprotegerin (OPG) acts as a decoy receptor for the "Receptor Activator of Nuclear Factor-kappaB Ligand" (RANKL), which is an essential factor for bone remodeling. This study was conducted to determine whether there were changes in maternal plasma OPG concentration during normal pregnancy. STUDY DESIGN A cross-sectional study was performed in 433 patients of reproductive age (40 nonpregnant and 393 pregnant). Pregnant patients were classified into 4 groups according to gestational age: group 1: 11 to 14 weeks (n = 100); group 2: 15 to 18 weeks (n = 99); group 3: 27 to 30 weeks (n = 100); and group 4: 37 to 42 weeks (n = 94). Plasma OPG concentrations were measured with the use of a sensitive and specific immunoassay. Nonparametric statistics were used for analysis. RESULTS OPG was detected in the plasma of all women tested. The median OPG concentration was significantly higher in term patients than in those in early pregnancy (median: 6.63 pmol/L [range: 1.57-25.57] vs median: 3.98 pmol/L [range: 0.41-13.71], P < .001). There was no significant difference in plasma OPG concentrations between nonpregnant women and those in groups 1 or 2 (nonpregnant women median: 3.86 pmol/L [range: 1.64-15.29] vs group 1 median: 3.98 pmol/L [range: 0.41-13.71] vs group 2 median: 3.87 pmol/L [range: 1.14-69.83], P = .75). CONCLUSION The median maternal plasma OPG concentration is higher in the third trimester than in the first trimester of pregnancy. OPG may be involved in the regulation of bone turnover during pregnancy.
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Affiliation(s)
- JOON-SEOK HONG
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - JOAQUIN SANTOLAYA-FORGAS
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, and
| | - ROBERTO ROMERO
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Address correspondence to: Roberto Romero, MD, Perinatology Research Branch, NICHD, Wayne State University/Hutzel Hospital, Dept. OB/GYN, 3990 John R, 4 Floor, Detroit, MI 48201, Phone: (313) 993-2700; Fax: (313) 993-2694, e-mail:
| | - JIMMY ESPINOZA
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, and
| | - LUÍS F. GONÇALVES
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, and
| | - YEON MEE KIM
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - SAMUEL EDWIN
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - BO HYUN YOON
- Department of Obstetrics and Gynecology, Seoul National University, Seoul, Korea; and
| | - JYH KAE NIEN
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | | | - MOSHE MAZOR
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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Gonen E, Sahin I, Ozbek M, Kovalak E, Yologlu S, Ates Y. Effects of pregnancy and lactation on bone mineral density, and their relation to the serum calcium, phosphorus, calcitonin and parathyroid hormone levels in rats. J Endocrinol Invest 2005; 28:322-6. [PMID: 15966504 DOI: 10.1007/bf03347197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to evaluate the net changes in bone mineral density (BMD) during the reproductive cycle, and their relation with changes in serum calcium (Ca), phosphorus (P), PTH and calcitonin levels in rats. Twenty-seven female Wistar rats were included in this study. They were divided into three groups as pregnant, lactating and control groups. BMDs of lumbar vertebrates, femoral and tibial bones, and Ca, P, calcitonin and PTH levels were measured at the end of pregnancy, at the end of lactation and in nulliparous controls. In the pregnant group, the BMDs of rats were significantly higher in lumbar vertebrates, femoral and tibia bones than those of the control group (p<0.05). Their PTH and Ca levels were significantly lower than the control group (p<0.05). However, no statistically significant difference was found regarding P and calcitonin levels when compared to those of the control group. In the lactating group, the BMDs were significantly lower in lumbar vertebrates, femoral and tibia bones than those seen in the control and pregnant groups (p<0.05). Ca and PTH levels were significantly higher in lactating rats than in those of pregnant rats (p<0.005). Normal pregnancy increases BMD in rats, whereas lactation decreases it. Change in PTH levels is supposed to contribute to the mineralization and demineralization of the skeleton during pregnancy and lactation, respectively.
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Affiliation(s)
- E Gonen
- SSK Ankara Hospital, Orthopedics, Ankara, Turkey
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Chaudhuri A. Why we should offer routine vitamin D supplementation in pregnancy and childhood to prevent multiple sclerosis. Med Hypotheses 2005; 64:608-18. [PMID: 15617877 DOI: 10.1016/j.mehy.2004.06.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2004] [Accepted: 06/24/2004] [Indexed: 10/26/2022]
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that runs a chronic course and disables young people. The disease is more prevalent in the geographic areas that are farthest from the equator. No form of treatment is known to be effective in preventing MS or its disabling complications. A number of epidemiological studies have shown a protective effect of exposure to sunlight during early life and a recent longitudinal study confirmed that vitamin D supplementation reduced life-time prevalence of MS in women. Very little is known regarding the role of vitamin D on the developing brain but experimental data suggest that cerebral white matter is vitamin D responsive and oligodendrocytes in the brain and spinal cord and express vitamin D receptors. It is possible that differentiation and axonal adhesion of oligodendrocytes are influenced by vitamin D level during brain development and a relative lack of vitamin D may increase oligodendroglial apoptosis. The age effect of migration on susceptibility to develop MS could be explained by a role of vitamin D on brain development. In areas of high MS prevalence, dietary supplementation of vitamin D in early life may reduce the incidence of MS. In addition, like folic acid, vitamin D supplementation should also be routinely recommended in pregnancy. Prevention of MS by modifying an important environmental factor (sunlight exposure and vitamin D level) offers a practical and cost-effective way to reduce the burden of the disease in the future generations.
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Affiliation(s)
- Abhijit Chaudhuri
- Department of Neurology, Institute of Neurological Sciences, 1345 Govan Road, Glasgow G51 4TF, UK.
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Sukonpan K, Phupong V. Serum calcium and serum magnesium in normal and preeclamptic pregnancy. Arch Gynecol Obstet 2004; 273:12-6. [PMID: 15480721 DOI: 10.1007/s00404-004-0672-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Accepted: 07/06/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aims of this study were to measure serum levels of calcium and magnesium in preeclamptic pregnancies and to compare them with those in normal pregnancies. MATERIALS AND METHODS We collected venous serum samples from 40 preeclamptic pregnant women and 40 normal pregnant women. The blood samples were analyzed for calcium and magnesium, using a colorimetric analyzer. The data were analyzed using the Student's t-test, chi2-test or Fisher exact tests when appropriate. RESULTS The serum calcium concentration in preeclamptic pregnant women is significantly lower than that in normal pregnant women (9.0 +/- 0.4 mg/dl vs. 9.7 +/- 0.7 mg/dl, p < 0.0001). Like serum calcium, serum magnesium concentration in preeclamptic women is significantly lower than that in normal pregnant women (0.77 +/- 0.08 mmol/l vs. 0.85 +/- 0.09 mmol/l, p = 0.001). CONCLUSION This study shows that both serum calcium and serum magnesium levels in preeclamptic pregnant women are lower than in normal pregnant women. These findings support the hypothesis that hypocalcemia and hypomagnesemia are possible etiologies of preeclampsia.
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Affiliation(s)
- Kanchapan Sukonpan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
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