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Bone remodeling and bone mineral density during pregnancy

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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction.

The effect of pregnancy upon the maternal skeleton is not fully understood. The information that has been gathered by recent studies is conflicting with regard to overall loss or gain of bone during pregnancy. The aim of the present longitudinal, controlled study, therefore, was to investigate the effect of pregnancy on lumbar spine, wrist, and hip bone mineral density, and to describe bone remodeling during pregnancy as indicated by biochemical markers of both bone resorption and formation.

Materials and methods.

Thirty healthy women (15 subjects seeking pregnancy and 15 non-pregnant controls) were studied. Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry before conception and within 2 weeks after parturition. Markers of bone resorption (urinary cross-linked type I collagen N-telopeptides, serum type I collagen C-telopeptides) and bone formation (total and bone specific alkaline phosphatase, osteocalcin), and total serum calcium were analyzed before, during (once in each trimester), and after pregnancy.

Results.

During pregnancy, BMD decreased significantly by 3.4±4.1% at the lumbar spine and 4.3±3.9% at the trochanter, while there was a slight but significant increase in BMD at the proximal 1/3 of the forearm (1.3±1.9%). Total hip and femoral neck BMD did not change significantly, nor did total and ultradistal forearm BMD. Bone resorption increased during pregnancy with peak levels in the third trimester (N-telopeptides) or post partum (C-telopeptides), respectively. The increase in bone resorption was accompanied by a significant decrease in serum calcium in the third trimester. Markers of bone formation showed a biphasic pattern with decreases from baseline to the first (total and bone specific alkaline phosphatase) or second trimester (osteocalcin), respectively, followed by a significant increase in the third trimester and post partum. There was no change in any parameter in the control group throughout the study.

Conclusion.

In conclusion, pregnancy is characterized by high bone turnover with resorption preceding formation. During the first and second trimester bone remodeling is uncoupled. Serum calcium decreases as bone resorption peaks in late pregnancy. There are significant decreases in bone mineral density at sites rich in trabecular bone, such as the lumbar spine and the trochanter.

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References

  1. Black AJ, Topping J, Durham B, Farquharson RG, Fraser WD (2000) A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J Bone Miner Res 15:557–563

    Article  CAS  PubMed  Google Scholar 

  2. Christiansen C, Rodbro P, Heinild B (1976) Unchanged total body calcium in normal human pregnancy. Acta Obstet Gynecol Scand 55:141–143

    Article  CAS  PubMed  Google Scholar 

  3. Cross NA, Hillman LS, Allen SH, Krause GF, Vieira NE (1995) Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. Am J Clin Nutr 61:514–523

    CAS  PubMed  Google Scholar 

  4. Dahlman T, Sjöberg HE, Ringertz H (1994) Bone mineral density during long-term prophylaxis with heparin in pregnancy. Am J Obstet Gynecol 170:1315–1320

    Article  CAS  PubMed  Google Scholar 

  5. Drinkwater BL, Chesnut CH III (1991) Bone density during pregnancy and lactation in active women: a longitudinal study. Bone Miner 14:153–160

    Article  CAS  PubMed  Google Scholar 

  6. Gallacher SJ, Fraser WD, Owens OJ, Dryburgh FJ, Logue FC, Jenkins A, Kennedy J, Boyle IT (1994) Changes in calcitropic hormones and biochemical markers of bone turnover in normal human pregnancy. Eur J Endocrinol 131:369–374

    Article  CAS  PubMed  Google Scholar 

  7. Goss H, Schmidt CLA (1930) Calcium and phosphorus metabolism in rats during pregnancy and lactation and the influence of the reaction of the diet thereon. J Biol Chem 86:417–432

    CAS  Google Scholar 

  8. Hosking DJ (1996) Calcium homeostasis in pregnancy. Clin Endocrinol (Oxf) 45:1–6

    Google Scholar 

  9. Khastgir G, Studd JWW, King H, Abdalla H, Jones J, Carter G, Alaghband-Zadeh J (1996) Changes in bone density and biochemical markers of bone turnover in pregnancy-associated osteoporosis. Br J Obstet Gynaecol 103:716–718

    Article  CAS  PubMed  Google Scholar 

  10. Lamke B, Brundin J, Moberg P (1977) Changes of bone mineral content during pregnancy and lactation. Acta Obstet Gynecol Scand 56:217–219

    Article  CAS  PubMed  Google Scholar 

  11. Matsumoto I, Kosha S, Noguchi S, Kojima N, Oki T, Douchi T, Nagata Y (1995) Changes of bone mineral density in pregnant and postpartum women. J Obstet Gynaecol 21:419–425

    Article  CAS  Google Scholar 

  12. Melton LJ III, Bryant SC, Wahner HW, O'Fallon WM, Malkasian GD, Judd HL, Riggs BL (1993) Influence of breastfeeding and other reproductive factors on bone mass later in life. Osteoporos Int 3:76–83

    Article  PubMed  Google Scholar 

  13. Miller SC, Shupe JG, Redd EH, Miller MA, Omura TH (1986) Changes in bone mineral and bone formation rates during pregnancy and lactation in rats. Bone 7:283–287

    Article  CAS  PubMed  Google Scholar 

  14. Naylor KE, Iqbal P, Fledelius C, Fraser RB, Eastell R (2000) The effect of pregnancy on bone density and bone turnover. J Bone Miner Res 15:129–137

    Article  CAS  PubMed  Google Scholar 

  15. Nordin BEC, Roper A (1955) Post-pregnancy osteoporosis. A syndrome? Lancet 1:431–434

    Article  Google Scholar 

  16. Purdie DW, Aaron JE, Selby PL (1988) Bone histology and mineral homeostasis in human pregnancy. Br J Obstet Gynaecol 95:849–854

    Article  CAS  PubMed  Google Scholar 

  17. Rodin A, Duncan A, Quartero HWP, Pistofidis G, Mashiter G, Whitaker K, Crook D, Stevenson JC, Chapman MG (1989) Serum concentrations of alkaline phosphatase isoenzymes and osteocalcin in normal pregnancy. J Clin Endocrinol Metab 68:1123–1127

    Article  CAS  PubMed  Google Scholar 

  18. Shahtaheri SM, Aaron JE, Johnson DR, Purdie DW (1999) Changes in trabecular bone architecture in women during pregnancy. Br J Obstet Gynaecol 106:432–438

    Article  CAS  PubMed  Google Scholar 

  19. Sowers MF (1996) Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 11:1052–1060

    Article  CAS  PubMed  Google Scholar 

  20. Sowers MF, Crutchfield M, Jannausch M, Updike S, Corton G (1991) A prospective evaluation of bone mineral change in pregnancy. Obstet Gynecol 77:841–845

    CAS  PubMed  Google Scholar 

  21. Sowers MF, Randolph J, Shapiro B, Jannausch M (1995) A prospective study of bone density and pregnancy after an extended period of lactation with bone loss. Obstet Gynecol 85:285–289

    Article  CAS  PubMed  Google Scholar 

  22. Sowers MF, Scholl T, Harris L, Jannausch M (2000) Bone loss in adolescent and adult pregnant women. Obstet Gynecol 96:189–193

    CAS  PubMed  Google Scholar 

  23. Ulrich U, Pfeifer T, Lauritzen C (1994) Rapid increase in lumbar spine bone density by high-dose intramuscular estrogen-progestogen injections: a preliminary report. Horm Metab Res 26:428–431

    Article  CAS  PubMed  Google Scholar 

  24. Ulrich U, Pfeifer T, Buck G, Lauritzen C (1995) Osteopenia in primary and secondary amenorrhea. Horm Metab Res 27:432–435

    Article  CAS  PubMed  Google Scholar 

  25. Yamaga A, Taga M, Minaguchi H, Sato K (1996) Changes in bone mass as determined by ultrasound and biochemical markers of bone turnover during pregnancy and puerperium: a longitudinal study. J Clin Endocrinol Metab 81:752–756

    CAS  PubMed  Google Scholar 

  26. Yamaga A, Taga M, Minaguchi H (1997) Changes in urinary excretions of C-telopeptide and cross-linked N-telopeptide of type I collagen during pregnancy and puerperium. Endocr J 44:733–738

    Article  CAS  PubMed  Google Scholar 

  27. Yasumizu T, Kato J (1996) Concentrations of serum markers of type I collagen synthesis and degradation and serum osteocalcin in maternal and umbilical circulation. Endocr J 43:191–195

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements.

The excellent laboratory work of Gretchen Davis (Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA) is gratefully acknowledged. Special thanks go to Michael Davis (Osteoporosis Research Group, Division of Nuclear Medicine, University of Washington, Seattle, WA) who performed the bone mass measurements. Dr. Ulrich was supported by a German Research Foundation grant (Ul 142/1–1).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA

    U. Ulrich, P. B. Miller & M. R. Soules

  2. Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA

    D. R. Eyre

  3. Department of Radiology, University of Washington, Seattle, Washington, USA

    C. H. Chesnut III

  4. Department of Obstetrics and Gynecology, University of Bonn, Bonn, Germany

    U. Ulrich & H. Schlebusch

  5. Department of Obstetrics and Gynecology, University of Cologne School of Medicine, Kerpener Strasse 34, 50931, Cologne, Germany

    U. Ulrich

Authors
  1. U. Ulrich
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  2. P. B. Miller
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  3. D. R. Eyre
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  4. C. H. Chesnut III
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  5. H. Schlebusch
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  6. M. R. Soules
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Corresponding author

Correspondence to U. Ulrich.

Additional information

Presented in part at the 17th Meeting of the German-speaking University Lecturers of Obstetrics and Gynecology, Salzburg, Austria, October 3–5, 2001

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Ulrich, U., Miller, P.B., Eyre, D.R. et al. Bone remodeling and bone mineral density during pregnancy. Arch Gynecol Obstet 268, 309–316 (2003). https://doi.org/10.1007/s00404-002-0410-8

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  • DOI: https://doi.org/10.1007/s00404-002-0410-8

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