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Mutational analysis uncovers monogenic bone disorders in women with pregnancy-associated osteoporosis: three novel mutations in LRP5, COL1A1, and COL1A2

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Abstract

Summary

Pregnancy was found to be a skeletal risk factor promoting the initial onset of previously unrecognized monogenic bone disorders, thus explaining a proportion of cases with pregnancy-associated osteoporosis. Therapeutic measures should focus in particular on the normalization of the disturbed calcium homeostasis in order to enable the partial skeletal recovery.

Introduction

Pregnancy-associated osteoporosis (PAO) is a rare skeletal condition, which is characterized by a reduction in bone mineral density (BMD) in the course of pregnancy and lactation. Typical symptoms include vertebral compression fractures and transient osteoporosis of the hip. Since the etiology is not well understood, this prospective study was conducted in order to elucidate the relevance of pathogenic gene variants for the development of PAO.

Methods

Seven consecutive cases with the diagnosis of PAO underwent a skeletal assessment (blood tests, DXA, HR-pQCT) and a comprehensive genetic analysis using a custom-designed gene panel.

Results

All cases showed a reduced BMD (DXA T-score, lumbar spine − 3.2 ± 1.0; left femur − 2.2 ± 0.5; right femur − 1.9 ± 0.5), while the spine was affected more severely (p < 0.05). The trabecular and cortical thickness was overall reduced in HR-pQCT, while the trabecular number showed no alterations in most cases. The genetic analysis revealed three novel mutations in LRP5, COL1A1, and COL1A2.

Conclusion

Our data show that previously unrecognized monogenic bone disorders play an important role in PAO. Pregnancy should be considered a skeletal risk factor, which can promote the initial clinical onset of such skeletal disorders. The underlying increased calcium demand is essential in terms of prophylactic and therapeutic measures, which are especially required in individuals with a genetically determined low bone mass. The implementation of this knowledge in clinical practice can enable the partial recovery of the skeleton. Consistent genetic studies are needed to analyze the frequency of pathogenic variants in women with PAO.

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Funding

This project has received funding from the European Community’s Seventh Framework Programme under grant agreement no. 602300 (SYBIL) and the German Federal Ministry of Education and Research (BMBF) within the project “Detection and Individualized Management of Early Onset Osteoporosis (DIMEOS).”

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Author notes

  1. S. Butscheidt and A. Delsmann contributed equally to this work.

Authors and Affiliations

  1. Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany

    S. Butscheidt, A. Delsmann, T. Rolvien, F. Barvencik, T. Schinke, M. Amling & R. Oheim

  2. Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    T. Rolvien

  3. Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    M. Al-Bughaili, S. Mundlos & U. Kornak

  4. Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany

    M. Al-Bughaili, S. Mundlos & U. Kornak

  5. Max Planck Institute for Molecular Genetics, FG Development and Disease, Berlin, Germany

    M. Al-Bughaili, S. Mundlos & U. Kornak

  6. National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    R. Oheim

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  1. S. Butscheidt
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  2. A. Delsmann
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  3. T. Rolvien
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  7. T. Schinke
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  10. R. Oheim
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Corresponding author

Correspondence to R. Oheim.

Ethics declarations

This prospective approach is legitimated by approval through the local ethics committee (No. PV5364) and all investigations were carried out in accordance with the World Medical Association Declaration of Helsinki.

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Butscheidt, S., Delsmann, A., Rolvien, T. et al. Mutational analysis uncovers monogenic bone disorders in women with pregnancy-associated osteoporosis: three novel mutations in LRP5, COL1A1, and COL1A2. Osteoporos Int 29, 1643–1651 (2018). https://doi.org/10.1007/s00198-018-4499-4

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