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a Radiobiology Division, School of Medicine, University of Utah, Salt Lake City, Utah 84108-1218
b Department of Veterans Affairs Medical Center, Salt Lake City, Utah 84108
c Novartis Pharma AG, Basel, Switzerland
d Lovelace Respiratory Research Institute, Albuquerque, New Mexico 87185
| ABSTRACT |
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| INTRODUCTION |
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The effect of lactation on human skeletal metabolism has been inferred from serum chemistry or bone densitometry measurements because histomorphometric studies have not been conducted. Serum and urine markers of both bone formation and resorption are generally elevated during lactation [8]. Most longitudinal studies using bone densitometry performed at predominantly cancellous bone sites (e.g., vertebrae) have reported decreases in bone mass during lactation [5, 911], while a few studies have reported no measurable change in bone mass [12]. When measurements were made at predominantly cortical bone sites in humans, there were reports of decreases [1214], increases [8, 12], or no changes [5, 9, 11, 12, 14, 15] in bone mass during lactation.
Studies of lactation in animal models indicate that cancellous bone loss occurs during lactation in rats [16], dogs [17], sheep [18], pigs [19], and monkeys [20]. Histomorphometry reveals that the lactation-induced decrease in bone mass is associated with a marked increase in cancellous bone remodeling as reported in dogs [17, 21] and rats [4, 22]. Cortical bone mass decreases during lactation in rats, and this has been attributed to decreased periosteal apposition coupled with increased endocortical resorption and expansion of the medullary cavity [4, 23]. Increased intracortical bone remodeling has been reported to occur in rats during multiple lactations, but only when dietary calcium is restricted [24].
The intracortical bone changes that may occur during a normal lactation in a longer-lived, normally remodeling species are not known. The purpose of this study was to determine whether there are indications of increased intracortical bone remodeling during lactation in dogs. For this, a weight-bearing (femur) and a non-weight-bearing (rib) site from a group of beagle dogs during or immediately after lactation were analyzed using histomorphometric methods.
| MATERIALS AND METHODS |
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The skeletal tissues were obtained from a collection of tissues that had been archived from previous studies. For this, a rib and a femur were obtained from nine normal female beagle dogs; six were unmated controls (mean age: 59 mo), and three were dogs at the end of lactation (mean age: 50 mo; Table 1). The lactating dogs had lactated from 33 to 35 days. The normal lactation period for a beagle dog is about 35 days [25]. Two additional sets of bones became available to us from dogs that were 17 days postweaning. Although this did not represent a group large enough for statistical comparison, the data from the postlactational dogs are included as a preliminary observation. All animals had been maintained at a beagle colony at the University of Utah (Salt Lake City, UT) or at the Lovelace Respiratory Research Institute (Albuquerque, NM) and were used in studies that were approved by the Institutional Animal Use and Care Committees. The beagle dogs in these colonies were a homogeneous population because of selective inbreeding and crossbreeding [26]. All dogs had reached skeletal maturity, which typically occurs at about 13 mo of age in beagles [25], and significant age-related osteopenia is unlikely, as this typically does not occur before 125 mo of age [27]. The animals were given tap water ad libitum and fed a mixture of dry dog meal and canned beef with a total calcium:phosphorous ratio of about 1.2:1.
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Each dog had been given an i.v. injection of 20 mg/kg BW of tetracycline-HCl (Achromycin; Lederle Division, American Cyanamide Co., Pearl River, NY) at 18 and 17 days before necropsy. At 8 and 7 days before necropsy, the animals had been given an i.v. injection of 10 mg/kg BW calcein green (fluorescein-methylene-imino-diacetic acid; Sigma Chemical Co., St. Louis, MO).
The midfemoral diaphysis and a rib were fixed in 0.1 M phosphate-buffered 10% formalin for 24 h, dehydrated in ascending concentrations of ethanol, and embedded undecalcified in methyl methacrylate. Transverse sections of the rib and femoral shaft were cut with a low-speed saw (Isomet; Buehler Ltd., Lake Bluff, IL) and mounted on plastic slides. Slides were manually ground to approximately 3040 µm in thickness on a rotary grinding wheel (Ecomet 5; Buehler Ltd.) and polished.
Histomorphometry
Histomorphometry was performed on one entire rib cross section (58 mm2 of cortical bone) and from one or two entire femur cross sections (40110 mm2 of cortical bone). Measurements of tissue area, cortical bone area, and porosity were obtained by manual point-counting methods using a Merz (Klarmann Rulings, Inc., Manchester, NH) eyepiece reticule. Osteocyte lacunae were not counted as voids for porosity measurements. Only haversian canals and Volkmann's canals were considered to be voids. Dynamic histomorphometry measurements were performed on a fluorescence microscope equipped with a camera lucida and interfaced with a digitizing tablet and an Apple SE Computer (Apple, Cupertino, CA) running histomorphometry software (KSS Scientific Consultants, Magna, UT). Primary measured indices included the number of resorption, reversal, single-labeled (sL), and double-labeled (dL) osteons. Reversal osteons were defined as osteons containing both a resorption surface and some fluorochrome markers indicative of bone mineralization. In addition, the sL perimeter, dL perimeter, and the distance between double labels (inter-label width) were measured.
On the basis of the measured primary indices, the mineral apposition rate (MAR) was calculated as inter-label width divided by the time between labels. Because all sections were cut transverse to the long axis of the bone, MAR was not corrected for section obliquity. The volume-referent bone formation rate (BFRv) was calculated on the basis of the total mineralizing perimeter, where mineralizing perimeter equals dL perimeter + 1/2 sL perimeter, to account for label-escape.
The osteon diameter was measured using a Merz eyepiece reticule for 25 randomly selected, fluorochrome-labeled osteons from each bone, and the haversian canal diameter was measured from 25 randomly selected, unlabeled osteons. The measurement of osteon diameter from osteons that contained fluorochrome marker ensured that only osteons that had formed during the experimental period were quantified. The mean wall thickness was calculated as 1/2 (osteon diameter - haversian canal diameter), and the osteon formation time (
f) was calculated as mean wall thickness/MAR. In some bones with low bone turnover, there were fewer than 25 labeled osteons, and all labeled osteons present were measured. The activation frequency of the basic multicellular unit (BMU) was calculated as:
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Histomorphometric indices conformed to the recommendations made by the American Society for Bone and Mineral Research Nomenclature Committee [29].
Statistical Analysis
For each bone, differences between lactating and control dogs were tested using an unpaired, one-tailed, Student's t-test. For the static measurements of bone size (tissue area, cortical bone area) a two-tailed t-test was used, because the effects of pregnancy and lactation might have opposite effects on these measurements when compared to those in virgin controls [4]. A P value of less than 0.05 was considered statistically significant. Because of the relatively small number of animals in the groups and the inherent variability encountered in beagle dogs, mention is made of probability values in which 0.1 > P > 0.05, and these are considered only as statistical trends. Data are expressed as the mean ± standard error of the mean.
| RESULTS |
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In the rib from the lactation animals, the number of sL osteons and the number of resorption and reversal osteons were significantly greater than in the controls160% and 100% greater, respectively. None of the other measured indices were significantly greater in lactating dog ribs.
The effects of lactation on intracortical bone remodeling were more apparent in the femoral diaphyseal shaft, probably because of the much lower basal bone remodeling rates at this site. No significant differences in tissue area were observed, but a significant decrease in cortical bone area/tissue area was observed in lactating dogs. In the femur from one of the control dogs, no dL osteons were observed although a double label was confirmed in the rib. The calculated indices of mineral apposition rate, bone turnover, and osteon formation time were performed for the remaining five control dogs. Even with this animal excluded from the statistical evaluation, BMU activation frequency and the number of sL osteons and of resorption and reversal osteons were significantly greater in lactating dog femurs than in control dog femurs (235%, 400%, and 46%, respectively). There were statistical trends in the BFRv and MAR, which were 285% and 29% greater than their respective controls. The osteon formation time was less (20%) in the lactating dogs, but not significantly less, which could be attributed to a significant increase in the MAR rather than differences in osteon size, because no differences were observed in the mean wall thickness.
In both the rib and the femur, bone formation and mineral apposition rates were greatly elevated in the postlactating dogs with respect to both control and lactating dogs. The number of resorption osteons did not show a correspondingly large increase. Although the sample was too small for statistical comparison, the data suggest that postlactation is a recovery phase, with elevated bone formation to reconstitute skeletal stores lost during pregnancy and lactation.
| DISCUSSION |
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The basal intracortical bone turnover rates in the rib were much greater than those observed in the femoral mid-diaphyseal shaft in the control animals. These site-specific differences are consistent with previous studies that have documented the rib as a relatively high-turnover bone [32]. The changes that occurred as a result of lactation were generally more evident in the femur, perhaps because of the low basal bone remodeling rates, which permitted the changes to be more detectable. In addition to the more pronounced effect observed in the femur, there was lower variability encountered in the femur than in the rib among the animals. Intracortical bone remodeling in the canine rib is, however, known to be sensitive to endocrine manipulations: Wilson et al. [32] recently reported a 7-fold increase in bone turnover in the rib at 4 mo after ovariectomy.
The increased intracortical bone remodeling that was associated with lactation in the dog is consistent with previous reports of increased cancellous bone remodeling in this species [17, 21]. Analogous to the present study, these previous studies reported increases in cancellous bone-labeled perimeter, mineral appositional rates, volume referent bone formation rates, and eroded and osteoclast perimeter, indicative of accelerated bone turnover rates. Similar to what has been reported on dog cancellous bone, increased cancellous bone turnover is documented in the rat [4]. Unlike that in the dog, however, intracortical bone remodeling in the rat has not been observed during the reproductive cycle, except during multiple reproductive cycles and when calcium is restricted in the diet [24].
There are no histological or histomorphometric data available on intracortical bone remodeling during lactation in humans. However, depending on the study design, the age of the women used, and the methods employed, some investigators have found decreased mineral density at predominantly cortical bone sites during lactation. When multiple sites are compared, however, greater changes in bone mineral content or bone mineral density were usually observed at predominantly cancellous bone rather than cortical bone sites (reviewed in [31]). Interestingly, some of the greatest cortical bone changes (about 15% loss) were observed in teenage mothers who consumed less than the recommended daily allowances of calcium [33]. While bone loss at the endocortical surface may account for some of the changes observed in humans, the activation of intracortical bone remodeling during lactation, as demonstrated in the present study, would increase the remodeling space, resulting in a transient decrease in bone mineral density. Increased intracortical bone remodeling is also consistent with the serum and urine measurements that generally show both increased bone resorption and formation during lactation in humans (reviewed in [31]).
A transient increase in bone remodeling during lactation has been proposed as a mechanism to meet the calcium demands of milk production while maintaining the structural integrity of the maternal skeleton [23]. The activation of bone remodeling would help to accommodate the immediate calcium requirements of the neonate and would also provide an increased population of osteoclasts to respond to shorter- and longer-term calcium stresses. The subsequent increase in bone formation may serve to increase the capacity of the skeleton to serve as a systemic calcium buffer, as it is generally believed that mineral exchange occurs more readily in low-density bone. Elevated bone formation may also lead to a transient decrease in bone mineral content as more new osteons are formed, which typically have less mineral than mature osteons. Newly formed bone reaches approximately 65% of full mineralization very rapidly as new mineral crystallites are formed, but complete mineralization occurs much more slowly as the mineral crystallites grow in size [34, 35]. Bone remodeling would also replace older and presumably less structurally competent bone with younger bone, which may improve skeletal integrity over the longer term. This concept is supported with some human epidemiological data that show a positive correlation between reproductive cycles and the maintenance of the maternal skeleton in later life [36, 37]. Fox et al. [38], for example, calculated a 1.4% increase in bone density measured at the wrist for each birth. The data from the present study suggest that this may also be the result of a pronounced recovery phase that restores skeletal mineral lost during pregnancy and lactation.
The animals used in this study had from 2 to 7 pups in each litter. When the bone turnover values were reviewed for each individual animal, the one with the largest number of pups also had the highest bone turnover rates (data not shown). This might be expected because this animal would also have the greatest demands placed on its calcium homeostatic system, and it is consistent with previous reports demonstrating a positive correlation between the amount of bone loss and the number of lactating offspring [7, 39]. The differences in litter size between lactating and postlactating dogs, rather than the effects of lactation versus postlactation, may explain some of the variation in intracortical remodeling between the two groups. It was not possible to account for this in the present study and the data from postlactational dogs must be viewed as a preliminary finding.
The endocrine mechanisms involved in changes in intracortical and cancellous bone remodeling during lactation are not clear. The levels of the calciotrophic hormones, 1,25 dihydroxyvitamin D, 25-hydroxyvitamin D, and parathyroid hormone (PTH) do not correlate with concentrations of bone turnover markers or changes in bone mineral density measurements during lactation in women [40]. In the rat, PTH and vitamin D levels are elevated during lactation [41], but studies suggest that bone loss is independent of PTH and vitamin D levels [42]. Lactation is also a hypoestrogenic state, and a comparison of bone dynamics in the estrogen-deficient ovariectomized beagle with the lactation-induced changes observed in the present study reveals substantial similarities. Both lactation and ovariectomy [32] have transient increases in bone formation rate and turnover rates. Ovariectomy appears to have a larger effect on bone turnover than lactation in dogs, but this would be anticipated because of the sustained depletion of serum estrogen levels that occur after ovariectomy. PTH-related peptide (PTHrP) has also been considered as a possible endocrine mediator involved in increased bone turnover during lactation. PTHrP levels are elevated in maternal serum during lactation, and the levels are negatively correlated with changes in bone mineral density in the spine and the femoral neck [43].
In summary, this study demonstrates that there are substantial increases in intracortical bone remodeling during lactation in a long-lived, normally remodeling species. These data on cortical bone are consistent with the increases in cancellous bone remodeling that occur during lactation in multiple species. An increase in intracortical bone remodeling would result in a reduction in cortical bone mineral density, consistent with many reports in the human and consistent with metabolic markers of bone formation and resorption.
| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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2 Correspondence: Scott C. Miller, Division of Radiobiology, University of Utah, 729 Arapeen Dr., Salt Lake City, UT 84108-1218. FAX: 801 581 7008; scmiller{at}hsc.utah.edu ![]()
Accepted: July 20, 1999.
Received: April 28, 1999.
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This article has been cited by other articles:
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E. G. Vajda, B. M. Bowman, and S. C. Miller Cancellous and Cortical Bone Mechanical Properties and Tissue Dynamics During Pregnancy, Lactation, and Postlactation in the Rat Biol Reprod, September 1, 2001; 65(3): 689 - 695. [Abstract] [Full Text] [PDF] |
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