Bone metabolism in the fetus and neonate

Christopher S Kovacs1

  • 1Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada, ckovacs@mun.ca.

Insights

Fetal skeletal development relies on minerals like calcium and phosphorus, transported by the placenta. Postnatal bone growth requires vitamin D (calcitriol), but fetal mineral balance is regulated by parathyroid hormone (PTH).

Area of Science:

  • Skeletal Biology
  • Mineral Homeostasis
  • Embryonic Development

Background:

  • The skeleton forms from a cartilaginous scaffold replaced by bone through endochondral ossification, continuing until puberty.
  • Mineral delivery is crucial for skeletal growth and mineralization, with placental transport during fetal life and intestinal absorption after birth.

Purpose of the Study:

  • To elucidate the regulatory mechanisms of fetal and neonatal mineral and bone homeostasis.
  • To clarify the roles of various hormones and factors in skeletal development before and after birth.

Main Methods:

  • Analysis of limited human fetal data (cord blood, pathological specimens).
  • Extrapolation from animal studies involving surgical, pharmacological, and genetic manipulations.
  • Review of established physiological processes in mineral transport and bone formation.

Main Results:

  • Fetal mineral homeostasis depends on parathyroid hormone (PTH) and PTH-related protein, independent of vitamin D/calcitriol, calcitonin, or sex steroids.
  • Postnatal skeletal development necessitates active intestinal calcium absorption, reliant on vitamin D/calcitriol.
  • Neonatal calcitriol's role can be supplemented by dietary calcium or infusions.

Conclusions:

  • Hormonal regulation of mineral homeostasis differs significantly between fetal and postnatal development.
  • Parathyroid hormone is the primary regulator of fetal mineral balance, while vitamin D becomes essential after birth.

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