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ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture.
MedLine Citation:
PMID:  25209679     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Changes in bone density and in bone markers suggest that pregnancy is associated with deterioration of bone mass in the mother. The metabolism of calcium resets to allow the needs imposed by the building of the fetal skeleton. The fetus contributes in 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 growth hormone (PGH), which increases up to the end of pregnancy, may exert some anabolic effects, either directly or through the regulation of the insulin-like growth factor 1 (IGF1) production. Other key regulators of bone metabolism, like 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 acts as an additional pro-resorbing factor in bone. Osteoporosis and fragility fracture have been diagnosed, although rarely. The condition, however, is transitory because there is no long-term data supporting the deleterious effect of pregnancy on bone mass or fracture risk. 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.  
Authors:
Lucía Sanz-Salvador; Miguel A Garcia-Pérez; Juan J Tarín; Antonio Cano
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-9-10
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  -     ISSN:  1479-683X     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2014 Sep 
Date Detail:
Created Date:  2014-9-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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