Role of Parathyroid Hormone (PTH) and PTH-related Protein (PTHrP) in Regulating Mineral Homeostasis during Fetal Development

Parathyroid hormone (PTH) and PTH-related protein (PTHrP) play complementary and overlapping roles in regulating fetal mineral homeostasis. PTHrP is expressed within the growth plate, directs endochondral bone formation, and determines the fate of chondrocytes before bone formation can be initiated. It is expressed in placenta and is present at high levels in the fetal circulation. It stimulates placental calcium (and possibly magnesium) transfer and raises blood mineral levels above ambient maternal values in order to effect mineralization of the skeleton. It does not upregulate in response to absence of PTH or hypocalcemia, and thus, its secretion may be regulated autonomously or in response to placental signals. PTH is expressed in fetal parathyroids and placenta. Despite circulating at low levels, it has a more dominant effect than PTHrP in regulating the blood calcium and ensuring adequate mineralization of the skeleton. It may also have effects on bone formation in the steps that occur after apoptosis of hypertrophic chondrocytes. Unlike PTHrP, it increases with fetal hypocalcemia, but its secretion is constrained by the calcium-sensing receptor to maintain the adult calcium level, well below what the fetus normally achieves. PTH also stimulates placental calcium transfer, and its absence disrupts placental expression of calciotropic and cation transporter genes.