Calcium Metabolism and Bone Health During Pregnancy and Lactation
Summary
During pregnancy and lactation, maternal calcium requirements rise sharply to support foetal skeletal development and neonatal skeletal mineralisation. Adaptive mechanisms include increased intestinal calcium absorption mediated by upregulated calcitriol and parathyroid hormone-related protein, along with temporary mobilisation of maternal bone stores. In most women, these hormonal and skeletal changes are reversible after weaning, with bone mineral density restoring to baseline within months. However, a subset of individuals experience exaggerated bone loss, leading to fragility fractures during late gestation or early postpartum. Key determinants of maternal skeletal health in this period include baseline calcium intake, vitamin D status, genetic predisposition affecting Wnt signalling, lifestyle factors such as physical activity, and the intensity and duration of breastfeeding. Understanding the interplay between nutritional supplementation, endocrine regulation and bone remodelling is critical for optimising both maternal and offspring outcomes on a global scale.
Research from Nature Portfolio
Recent investigations into maternal bone metabolism have characterised dynamic shifts in bone‐forming and bone‐resorbing markers across late pregnancy and the early postpartum period. In a large cohort of pregnant women, levels of osteocalcin and tartrate‐resistant acid phosphatase rose after delivery, reflecting accelerated remodelling. Exclusive breastfeeding was shown to drive a further increase in bone resorption markers, whereas mixed feeding attenuated this effect. Importantly, women who sustained postpartum vertebral fractures exhibited lower baseline bone mineral density than those without fractures, suggesting that transient increases in resorption may precipitate fragility in individuals with low skeletal reserves.
Calcium Metabolism and Bone Health During Pregnancy and Lactation publication trend
The graph below shows the total number of articles in calcium metabolism and bone health during pregnancy and lactation across all publications each year (not limited to Nature Index journals).
Technical terms
Bone mineral density (BMD): The amount of mineral per unit area of bone, reflecting skeletal strength.
C-terminal telopeptide of type I collagen (CTX): A biochemical marker released during bone collagen degradation, indicating bone resorption activity.
Teriparatide: A recombinant fragment of parathyroid hormone that stimulates new bone formation.
Pregnancy- and lactation-associated osteoporosis (PLO): A rare condition characterised by significant bone loss and fragility fractures occurring during late pregnancy or lactation.
References
- Changes in bone metabolic profile associated with pregnancy or lactation. Scientific Reports (2019).
- Bone turnover in pregnancy, measured by urinary CTX, is influenced by vitamin D supplementation and is associated with maternal bone health: findings from the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial. American Journal of Clinical Nutrition (2021).
- Comparative Effectiveness of Therapeutic Interventions in Pregnancy and Lactation-Associated Osteoporosis: A Systematic Review and Meta-analysis. The Journal of Clinical Endocrinology & Metabolism (2023).
- Current and future perspectives on pregnancy and lactation-associated osteoporosis. Frontiers in Endocrinology (2024).
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