Bone Biomarkers in Gestational Hypertension

  • Despina D. Briana
  • Ariadne Malamitsi-PuchnerEmail author
Reference work entry
Part of the Biomarkers in Disease: Methods, Discoveries and Applications book series (BDMDA)


The skeletal system undergoes a continuous process of remodeling throughout life, which involves a delicate balance between bone resorption due to osteoclastic activation and new bone formation due to osteoblastic activity. Biochemical markers of bone turnover are reliable indices for measuring changes of bone formation and resorption, reflecting the dynamics of bone metabolism at the cellular level. During normal pregnancy, major changes occur in maternal calcium homeostasis and bone metabolism, in order to fulfill the calcium demand of the fetus for skeletal growth and mineralization. Fetal calcium requirements can be met by calcium mobilization from the maternal skeleton through hormone-mediated adjustment of maternal calcium metabolism. Due to limitations in the application of bone densitometry during pregnancy, biochemical markers are effective alternatives to estimate bone turnover. The diphasic changes in maternal bone histology (temporary loss of cancellous bone in early pregnancy restored by term gestation) are consistent with corresponding blood biochemistry changes: increased bone resorption markers in the first trimester, followed by elevated bone formation markers at term. Maternal bone turnover during pregnancy is reportedly enhanced in hypertensive disorders of pregnancy, including preeclampsia (PE) and pregnancy-induced hypertension (PIH), although data are not consistent. Biochemical markers provide evidence for increased maternal bone turnover in PE, probably leading to a further reduction in maternal bone mineral density (BMD). In contrast, in PIH, data are scarce and do not support considerable changes in maternal bone metabolism.


Pregnancy Preeclampsia Pregnancy-induced hypertension Bone turnover Biochemical markers Bone mineral density 

List of Abbreviations


Alkaline phosphatase


Bone-specific alkaline phosphatase


Bone mineral density


Body mass index




Cross-linked carboxyl-terminal telopeptide of type I collagen




N-telopeptide of type I collagen








Carboxyl-terminal pro-peptide of type I collagen


Pregnancy-induced hypertension




Receptor activator of nuclear factor-kB ligand


Transforming growth factor-β


Tumor necrosis factor-alpha


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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Department of NeonatologyAthens University Medical SchoolAthensGreece

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