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[Osteoporosis during pregnancy and lactation]
Marcelo Sarli1, Carina Hakim, Paula Rey
1Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires. msarli@yahoo.com
Medicina
|January 26, 2006
Summary
Maternal hormonal and metabolic shifts during pregnancy and lactation support fetal skeletal development by altering calcium absorption and bone metabolism. These physiological changes, while essential, can rarely lead to osteoporosis.
Area of Science:
- Reproductive Endocrinology
- Mineral Metabolism
- Skeletal Physiology
Background:
- Pregnancy and lactation necessitate significant maternal hormonal and metabolic adaptations for fetal and neonatal skeletal development.
- Key adjustments include increased intestinal calcium absorption, altered renal calcium excretion, and bone resorption to meet demands.
- Hormonal profiles change, with elevated 1,25-dihydroxyvitamin D3, estrogen, prolactin, and placental lactogen influencing calcium homeostasis.
Purpose of the Study:
- To review the published literature on the physiopathology of osteoporosis during pregnancy and lactation.
- To elucidate the hormonal and metabolic adjustments during gestation and postpartum that impact maternal bone health.
- To understand the role of various hormones and factors in calcium balance and skeletal integrity.
Main Methods:
- Literature review of published studies on maternal skeletal adaptations during pregnancy and lactation.
- Analysis of hormonal and metabolic changes affecting calcium homeostasis.
- Examination of factors contributing to bone metabolism and potential risks of osteoporosis.
Main Results:
- Calcium intestinal absorption increases significantly, peaking in the third trimester, while hypercalciuria may persist until lactation ceases.
- Plasma 1,25-dihydroxyvitamin D3 levels double early in pregnancy due to placental activity, remaining elevated until delivery.
- Parathyroid hormone levels may be normal or low, with parathyroid hormone-related peptide potentially compensating; calcitonin levels rise during pregnancy and fall during lactation.
Conclusions:
- Pregnancy and lactation involve complex hormonal and metabolic shifts to support fetal skeletal growth.
- While generally adaptive, these physiological changes can, in rare cases, predispose women to generalized or regional osteoporosis.
- Further research is needed to fully elucidate the roles of factors like tumor necrosis factor, interleukin 6, and osteoprotegerin.
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