title: Bone metabolism during pregnancy.
abstract: During pregnancy, mineral concentrations, of calcium and phosphorus in particular, are maintained at a high level in fetal blood so that the developing skeleton may accrete adequate mineral content. The placenta actively transports minerals for this purpose. Maternal intestinal absorption increases in order to meet the fetal demand for calcium, which is only partly dependent on calcitriol. Mineral regulation is essentially dependent on parathyroid hormone (PTH) and PTH-related protein (PTHrP). The calcium-sensing receptor (CaSR) regulates PTH and PTHrP production. If calcium intake is insufficient, the maternal skeleton will undergo resorption due to PTHrP. After birth, a switch from fetal to neonatal homeostasis occurs through increase in PTH and calcitriol, and developmental adaptation of the kidneys and intestines with bone turnover contributing additional mineral to the circulation. Calcium absorption becomes progressively active and dependent on calcitriol. The postnatal skeleton can transiently present with osteoposis but adequate mineral diet usually allows full restoration. Cases of primary osteoporosis must be identified. Loss of trabecular mineral content occurs during lactation in order to provide calcium to the newborn. This programmed bone loss is dependent on a "brain-breast-bone" circuit. The physiological bone resorption during reproduction does not normally cause fractures or persistent osteoporosis. Women who experience fracture are likely to have other causes of bone loss.
authors.affiliation: Unité d'endocrinologie, maladies osseuses, génétique et gynécologie, hôpital des Enfants, CHU de Toulouse, TSA 70034, 31059 Toulouse cedex 09, France; Inserm UMR 1043 (Centre de physiopathologie de Toulouse-Purpan, CPTP), université de Toulouse-Paul-Sabatier, 31059 Toulouse, France. Electronic address: salles.jp@chu-toulouse.fr.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Salles
mesh_terms: D000818:Animals; D016723:Bone Remodeling / Q000502:physiology*; D001842:Bone and Bones / Q000378:metabolism*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010024:Osteoporosis / Q000175:diagnosis / Q000628:therapy; D010281:Parathyroid Hormone / Q000502:physiology; D011247:Pregnancy / Q000378:metabolism* / Q000502:physiology; D044169:Receptors, Calcium-Sensing / Q000502:physiology
chemical_list: D010281:Parathyroid Hormone; D044169:Receptors, Calcium-Sensing
keywords: Grossesse; Lactation; Newborn; Nouveau-né; Osteoporosis; Ostéoporose; Parathyroid hormone-related protein; Pregnancy