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Bone Biomarkers in Gestational Hypertension

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Biomarkers in Bone Disease

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Abstract

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.

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Abbreviations

ALP:

Alkaline phosphatase

BALP:

Bone-specific alkaline phosphatase

BMD:

Bone mineral density

BMI:

Body mass index

DPD:

Deoxypyridinoline

ICTP:

Cross-linked carboxyl-terminal telopeptide of type I collagen

IL-6:

Interleukin-6

NTx:

N-telopeptide of type I collagen

OC:

Osteocalcin

OPG:

Osteoprotegerin

PE:

Preeclampsia

PICP:

Carboxyl-terminal pro-peptide of type I collagen

PIH:

Pregnancy-induced hypertension

PTH:

Parathormone

RANKL:

Receptor activator of nuclear factor-kB ligand

TGF-β:

Transforming growth factor-β

TNF-alpha:

Tumor necrosis factor-alpha

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Authors and Affiliations

  1. Department of Neonatology, Athens University Medical School, 19, Soultani Street, 10682, Athens, Greece

    Despina D. Briana & Ariadne Malamitsi-Puchner

Authors
  1. Despina D. Briana
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  2. Ariadne Malamitsi-Puchner
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Correspondence to Ariadne Malamitsi-Puchner .

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Editors and Affiliations

  1. Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom

    Vinood B. Patel

  2. Department of Nutrition and Dietetics, Division of Diabetes and Nutritional Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom

    Victor R. Preedy

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Briana, D.D., Malamitsi-Puchner, A. (2017). Bone Biomarkers in Gestational Hypertension. In: Patel, V., Preedy, V. (eds) Biomarkers in Bone Disease. Biomarkers in Disease: Methods, Discoveries and Applications. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7693-7_29

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