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Bone remodeling and bone mineral density during pregnancy.
Arch Gynecol Obstet 2003; 268(4):309-16AG

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.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. UweAUlrich@aol.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14504876

Citation

Ulrich, U, et al. "Bone Remodeling and Bone Mineral Density During Pregnancy." Archives of Gynecology and Obstetrics, vol. 268, no. 4, 2003, pp. 309-16.
Ulrich U, Miller PB, Eyre DR, et al. Bone remodeling and bone mineral density during pregnancy. Arch Gynecol Obstet. 2003;268(4):309-16.
Ulrich, U., Miller, P. B., Eyre, D. R., Chesnut, C. H., Schlebusch, H., & Soules, M. R. (2003). Bone remodeling and bone mineral density during pregnancy. Archives of Gynecology and Obstetrics, 268(4), pp. 309-16.
Ulrich U, et al. Bone Remodeling and Bone Mineral Density During Pregnancy. Arch Gynecol Obstet. 2003;268(4):309-16. PubMed PMID: 14504876.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bone remodeling and bone mineral density during pregnancy. AU - Ulrich,U, AU - Miller,P B, AU - Eyre,D R, AU - Chesnut,C H,3rd AU - Schlebusch,H, AU - Soules,M R, Y1 - 2003/01/08/ PY - 2002/08/06/received PY - 2002/08/09/accepted PY - 2003/9/25/pubmed PY - 2004/2/5/medline PY - 2003/9/25/entrez SP - 309 EP - 16 JF - Archives of gynecology and obstetrics JO - Arch. Gynecol. Obstet. VL - 268 IS - 4 N2 - 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. SN - 0932-0067 UR - https://www.unboundmedicine.com/medline/citation/14504876/Bone_remodeling_and_bone_mineral_density_during_pregnancy_ L2 - https://dx.doi.org/10.1007/s00404-002-0410-8 DB - PRIME DP - Unbound Medicine ER -