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Mayo Clinic (D.J.R., G.E., T.E.H., K.M.W., S.K., T.C.S.), Rochester, Minnesota 55905; Department of Nutrition and Exercise Sciences (U.T.I., J.C.H., R.T.T.), Oregon State University, Corvallis, Oregon; and Department of Cell Biology (J.P.L., B.W.O.), Baylor College of Medicine, Houston, Texas 77030
Address all correspondence and requests for reprints to: Urszula T. Iwaniec, Ph.D., Department of Nutrition and Exercise Sciences, 108 Milam Hall, Oregon State University, Corvallis, Oregon 97331. E-mail: Urszula.Iwaniec{at}oregonstate.edu.
| Abstract |
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| Introduction |
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Clinical studies report variable effects of progesterone on bone mass. In postmenopausal women, progesterone was reported to reduce cortical but not cancellous bone loss, and combined estrogen and progestin therapy was reported to be as effective as high-dose estrogen alone in preventing overall bone loss (2, 3, 4). Part of the effect to reduce bone resorption may have been due to displacement of cortisol by progesterone from the osteoblast glucocorticoid receptor (5). Progesterone treatment was reported to increase spinal cancellous bone density in premenopausal women with menstrual disturbances (6). In these patients, the serum levels of estrogen are variable, but the levels of progesterone are universally diminished. On the other hand, the synthetic progesterone medroxyprogesterone acetate (MPA), which is used to suppress ovulation by decreasing pituitary gonadotropin output, is associated with a decrease in bone mineral density (7). The reduction in bone mass associated with MPA has been variously attributed to decreased estrogen production (7) and occupation by MPA of the glucocorticoid receptor (8).
Studies of laboratory animals generally support weak anabolic effects of progesterone on the skeleton. In contrast to ovariectomy (OVX), pseudopregnancy (a condition of estrogen deficiency with elevated progesterone) was not associated with cancellous bone loss in the rat (9). Moreover, in OVX rodents and dogs, physiological concentrations of progesterone have been reported to prevent bone loss from multiple sites and in some cases actually stimulate new bone formation, particularly of cortical bone (10, 11). Pharmacological concentrations of progesterone administered to OVX rodents was reported to increase periosteal bone formation, inhibit bone resorption, and enhance estrogen-induced bone formation at endocortical surfaces (12, 13).
However, not all studies report beneficial effects of progesterone on bone metabolism in postmenopausal women or OVX rats. Specifically, some investigators have failed to demonstrate an effect of progesterone, with or without estrogen, on OVX-induced bone loss in rats (14, 15). Furthermore, the antiprogesterone RU486 was shown to reduce bone loss in OVX rats (16). Finally, more recent clinical trials dispute the earlier claims that progesterone replacement therapy improves bone density in postmenopausal, premenopausal, OVX, or amenorrheic women (1, 17, 18).
At the cellular level, progesterone exerts its physiological effects by binding to and activating the progesterone receptor (PR), a member of the steroid nuclear receptor transcription factor family. The PR subsequently binds directly or indirectly to the regulatory regions of target genes and modulates transcription (19). Of the various cell types present in the bone microenvironment, osteoblasts have been shown to express PR (20, 21), and the level of PR expression in these cells can be stimulated by estrogen (20, 21, 22). As a result, it is possible that some of the effects on bone metabolism attributed to estrogen may be mediated by progesterone.
In an attempt to clarify the role of progesterone signaling in bone, we analyzed bone growth and turnover in mice carrying a null mutation in the PR locus [PR knockout (PRKO mice] (23). PRKO mice lack transcripts and protein for both PR-A and PR-B isoforms and exhibit abnormalities in the brain and multiple reproductive tissues, including the ovary, uterus, and mammary gland, leading to infertility in homozygous females. Here we report that PRKO mice exhibit site-specific increases in cancellous and cortical bone mass during adolescence.
| Materials and Methods |
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Histological processing
Whole tibiae were fixed in 70% ethanol for at least 72 h at 4 C. For analysis of cancellous bone, proximal tibiae were dehydrated in a graded ethanol series, infiltrated, and then embedded in plastic resin at room temperature. The resin comprised 88.5% (vol/vol) methyl methacrylate (Fisher Scientific, Pittsburgh, PA), 7% (vol/vol) hydroxyethyl methacrylate, 4.4% (vol/vol) dibutyl phthalate (Polysciences, Warrington, PA), 8.8% (wt/vol) polyethylene glycol distearate (Polysciences), and 0.8% (wt/vol) benzoyl peroxide (Aldrich Chemical Co., Milwaukee, WI). The undecalcified bone was then sectioned at 5 µm on a Reichert-Jung Supercut 2050 microtome. For analysis of cortical bone, diaphyseal cross-sections of tibiae (150 µm thick) were cut at the tibia-fibular synostosis, ground to 15–20 µm on a roughened glass plate, and mounted in Permount.
Histomorphometry
Bone histomorphometry was used to assess static and dynamic skeletal changes. Histomorphometric measurements were performed using the OsteoMeasure Analysis system (OsteoMetrics, Atlanta, GA). Longitudinal growth rate in 6-, 12-, and 26-wk-old mice was calculated in the proximal tibia from the mean distance between the most proximal label and the distal edge of the growth plate measured at five different sites across the metaphysis. Cancellous bone area/tissue area was measured in the proximal tibial epiphysis and metaphysis. Trabecular number (per millimeter), trabecular thickness (µm), and trabecular separation (µm) were calculated as described (24, 25). Osteoclasts were identified by staining for tartrate-resistant acid phosphatase (TRAP) using an azo-dye coupling method with naphthol AS-TR phosphate and acetate-buffered saline (pH 5.5) as substrate. Sections were counterstained with methyl-green thionine in citrate buffer (pH 5.8). Fluorochrome-based indices of cancellous bone formation were measured and included 1) mineralizing perimeter/bone perimeter (cancellous bone perimeter covered with double plus half single fluorochrome label), 2) mineral apposition rate (the distance between two fluorochrome markers that comprise a double label divided by the number of days between label administration, micrometers per day), and 3) bone formation rate (calculated by multiplying mineralizing perimeter by mineral apposition rate) normalized to bone perimeter (square micrometers per micrometer per day) and tissue area (percent per day). For cortical bone, cross-sectional area and medullary area were measured and cortical area calculated as the difference between the two endpoints. All histomorphometric data were collected by the same individual and are reported in accordance with standard nomenclature (24).
µCT
µCT was used for nondestructive three-dimensional evaluation of bone architecture in 12-wk-old mice. Humeri were scanned using a Scanco µCT40 scanner (Scanco Medical AG, Basserdorf, Switzerland) at a voxel size of 12 x 12 x 12 µm and a threshold of 256 (gray scale, 0–1000). The threshold value was determined empirically. Entire humeri (cancellous plus cortical bone) were evaluated followed by evaluation of cancellous bone in the distal humeral epiphysis and cortical bone at the humeral midshaft. For the humeral epiphysis, about 20 slices (0.24 mm) of bone were measured and included cancellous bone only. Direct cancellous bone measurements included 1) cancellous bone volume/tissue volume (volume of tissue occupied by cancellous bone, percent), 2) trabecular number (number of trabeculae within the sampled tissue, per millimeter), 3) trabecular thickness (mean thickness of individual trabeculae, micrometers), and 4) trabecular separation (the distance between trabeculae, micrometers) (26). For the humeral midshaft, 20 slices (0.24 mm) of cortical bone were evaluated and total cross-sectional tissue volume (cortical and marrow volume, cubic millimeters), cortical volume (cubic millimeters), and marrow volume (cubic millimeters) determined.
Statistical analysis
Statistical significance was determined between WT and PRKO mice and across age groups using ANOVA followed by a Tukeys post hoc test. A P value of <0.05 was considered statistically significant. All data are expressed as mean ± SE.
| Results |
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Body and uterine weight
Body and uterine wet weights of both PRKO and WT mice were measured at the time of killing and are shown in Fig. 1
, A and B, respectively. Both body weight and uterine weight increased progressively during the experiment. However, significant differences in either body weight or uterine weight between PRKO and WT control mice were not detected at any age examined. The lack of a difference in uterine weight is consistent with earlier findings that abnormalities in the size and morphology of the PRKO mouse uterus only become evident after OVX and hormonal stimulation (23).
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Cancellous bone histomorphometry: proximal tibial epiphysis
Cancellous bone architecture in the proximal tibial epiphysis is shown in Fig. 2
. Cancellous bone area normalized to tissue area in WT mice was higher in 12- and 26-wk-old than in 6-wk-old animals (Fig. 2A
). In the PRKO mice, cancellous bone area/tissue area was higher in 12-wk-old animals than in 6-wk-old animals. Significant differences in bone area/tissue area between PRKO and WT control mice were not detected at any age. Trabecular number increased in WT mice between 6 and 12 wk of age, whereas this endpoint did not change with age in PRKO mice (Fig. 2B
). Trabecular thickness did not change with age irrespective of genotype (Fig. 2C
). At 6 wk of age, trabecular separation was larger in WT compared with age-matched PRKO mice (Fig. 2D
). Trabecular separation was also lower in 12- and 26-wk-old WT mice than in 6-wk-old WT mice. Differences in trabecular separation were not detected in PRKO mice with age. Fluorochrome labels were measured to evaluate the effects of age and genotype on bone formation at the proximal tibia epiphysis (data not shown). In both genotypes, the cancellous mineral apposition rate increased between 12 and 26 wk of age, whereas there were no changes in the extent of mineralizing perimeter. Similarly, bone formation increased in both genotypes between 12 and 26 wk of age. These findings suggest that the number of active osteoblasts on trabecular surfaces does not change during the first 26 wk of age in the epiphysis, but the activity of individual cells increases. The cancellous bone formation rate increased in parallel with the mineral apposition rate, and thus the age-related increase in cancellous bone formation was principally due to an increase in osteoblast activity.
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To assess possible differences in osteoclasts at the cancellous bone surface between WT and PRKO mice, sections from proximal tibial epiphysis and metaphysis of 12- and 26-wk-old mice were stained for TRAP activity. At 12 wk of age, no differences in the frequency of TRAP+ mono- or multinucleated cells were observed between the genotypes (data not shown) in either the epiphysis or metaphysis. However, at 26 wk, there was a tendency for PRKO mice to have a lower osteoclast perimeter/bone perimeter (–22%, P = 0.1) and a lower osteoclast perimeter/tissue area (–39%, P = 0.1) compared with WT mice.
Cortical bone histomorphometry: tibial diaphysis
There was a significant increase in tibia cross-sectional area between 6 and 26 wk of age in PRKO but not WT mice (Table 1
). Progressive increases in cortical bone area were observed for both genotypes between 6 and 12 and 12 and 26 wk of age. In contrast, there were no age-related changes in medullary area for either genotype.
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| Discussion |
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Physiological concentrations of progesterone, when administered to osteopenic OVX rats, have been reported in some studies to produce a weak anabolic effect on cortical bone mass with no changes in resorption (10). At pharmacological concentrations, progestagens administered to OVX mice increase periosteal, but not endocortical, bone formation and may also reduce endocortical resorption (12). In the rat, progesterone has been reported to enhance the bone-preserving effects of estrogen by augmenting its suppression of bone resorption (27). However, none of these studies address whether signaling through PR is essential in normal bone growth and bone turnover.
The increased cortical bone mass observed in PRKO mice in the present study suggests that PR signaling may slightly antagonize radial bone growth during puberty, contributing to the sexual dimorphism of the skeleton. Our results in PRKO mice are qualitatively similar but smaller in magnitude than changes observed in OVX rats. In the rat tibia, reduced gonadal hormone levels are associated with substantial increases in periosteal bone formation and cortical bone area (28). The cortical bone changes in the 12-wk-old PRKO mice are also reminiscent of those in postpubertal estrogen receptor-β (ERβ) KO female mice (29), suggesting that estrogen signaling via ERβ and progesterone signaling via PR act cooperatively to reduce radial bone growth in females.
The cancellous bone volume, bone formation indices, and trabecular architecture were largely unaffected at the proximal tibial epiphysis by PR gene deletion. This indicates that, in ovary-intact animals, PR signaling is not required at this location for cancellous bone growth and turnover. The circulating concentrations of progesterone, estrogen, and FSH are within the normal range in PRKO mice (30). Also, uterine weight, a sensitive indicator of gonadal hormone status, showed parallel increases with age in the two genotypes. However, we cannot be certain there are no changes in the levels of other hormones that may exert compensatory effects on bone growth and turnover. For example, PRKO mice have elevated levels of prolactin and LH (30).
Our failure to detect age- and genotype-related changes in cancellous bone area in the proximal tibial epiphysis contrasts with the changes observed in the proximal tibial metaphysis. In the metaphysis, trabecular number decreased precipitously between 12 and 26 wk of age in WT but not in PRKO mice. This finding is in agreement with previous analysis of the effects of age on cancellous bone architecture in long bones of various strains of mice (31). Similarly, OVX in rats results in preferential loss of cancellous bone from the metaphysis but not the epiphysis (32). In rats, this differential response of the cancellous bone compartments to gonadal hormone insufficiency was attributed to the higher strain energy levels in the epiphysis, and the same mechanism may apply to mice.
No genotype-related differences in the microarchitecture of the epiphysis of skeletally mature mice were noted between WT and PRKO mice. However, the bone formation rate increased in both genotypes between 12 and 26 wk of age. As described below, a similar age-related increase in bone formation occurred at proximal tibial metaphysis in PRKO but not WT mice.
Compared with age-matched WT mice, bone formation in the proximal tibial metaphysis was increased in 26-wk-old PRKO mice. In addition, the PRKO mice showed a tendency for decreased osteoclast number. Taken together, these data indicate that PR signaling in WT mice prevents the compensatory increase in bone formation required to maintain cancellous bone architecture in adult mice.
Interestingly, disturbances in uterine growth/physiology only became evident in the PRKO female mice after OVX and hormonal stimulation (23), and therefore it would be of interest to determine whether the skeletal response of OVX PRKO mice to estrogen is impaired relative to OVX WT mice. This approach would address the possible involvement of PR-mediated secondary responses in the effects of estrogen on bone. In addition, progesterone may play a role in the regulation of calcium homeostasis and bone turnover during pregnancy and lactation, when progesterone levels are elevated. Pregnancy is associated with a positive calcium balance and increased cancellous bone volume, whereas it has been shown that lactation in rats and humans can lead to a net loss of calcium from bone, increased turnover, and cancellous bone loss (33, 34). Unfortunately, we cannot use this model to assess the role of progesterone in calcium homeostasis and bone turnover during pregnancy, because PRKO animals are infertile.
Progesterone has been reported to stimulate markers of bone formation in fetal rat calvarial organ culture and in a model of bone matrix-induced endochondral bone formation (35, 36). In contrast, the steroid had minimal effects, either alone or in combination with estradiol, on mature osteoblast-like cells cultured in vitro (37). However, a modest increase in cell proliferation and differentiation has been observed in vitro by some investigators (38, 39, 40). The differences observed between in vivo and in vitro model systems and those observed among different in vitro models suggest that PR signaling interacts with other regulatory pathways and that some of these pathways may be absent from some of the in vitro systems.
The extent of progesterones effect on bone may not be fully appreciated in the present analysis of PRKO mice. It is now known that human PR exists in two isoforms, A and B, which are generated from a single gene through alternate promoters, both of which are estrogen inducible (41). The PR-A isoform is transcriptionally less active than PR-B and under certain circumstances can inhibit the transcriptional activity of PR-B as well as the estrogen and mineralocorticoid receptors (42, 43, 44). Progesterone exhibited antiestrogenic growth-inhibitory activity on uterine epithelia in WT mice due to PR-A-mediated suppression of both ER and PR-B activity. Selective ablation of the PR-A isoform (PRAKO mice) was demonstrated to enhance the responsiveness of uterine epithelium to progesterone (45). In the PRAKO mouse, progesterone alone (through PR-B) increased uterine cell proliferation and enhanced the stimulatory effect of estrogen. Consequently, and in an analogous manner, the response of bone in vivo, and of osteoblasts in vitro, to progesterone may be altered by null mutation of PR-A. The progesterone response in bone may thus be impaired by PR-A, as it is in the uterus. In support of this possibility, osteoblasts in vitro express the A and B isoforms of PR at comparable levels, and both isoforms are induced by estrogen treatment (22). An analysis of the skeleton of PRAKO mice is therefore necessary to elucidate the relative roles of PR-A and -B in progesterone action on bone.
The present studies are directed toward the role of PR signaling in growing and young adult mice. It will be useful to perform studies in aged PRKO mice to investigate the possible role of the PR in the etiology of senile and/or postmenopausal osteoporosis.
In summary, gross abnormalities in bone growth and turnover were not observed between female WT and PRKO mice. However, ablation of the PR had effects on bone growth and turnover at selective skeletal sites. Specifically, PR signaling reduced accumulation of cortical and cancellous bone before peak bone mass.
| Footnotes |
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Current address for D.J.R.: Musculoskeletal Diseases Biology, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, Pennsylvania 19426.
Current address for K.M.W.: Computational Biology and Bioinformatics, Pacific Northwest National Laboratory, PO Box 999 MS K7-90, Richland, Washington 99352.
Disclosure Statement: The authors have nothing to disclose.
First Published Online February 14, 2008
Abbreviations: ER-β, Estrogen receptor-β; µCT, microcomputed tomography; KO, knockout; MPA, medroxyprogesterone acetate; OVX, ovariectomized; PR, progesterone receptor; TRAP, tartrate-resistant acid phosphatase; WT, wild type.
Received September 10, 2007.
Accepted for publication February 5, 2008.
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