Osteoporosis in Pregnant and Lactating Females: An Update

Abstract

The purpose of writing this review is to provide an update on recent advances in pregnancy and lactation-associated osteoporosis (PLO) research and summarize the current evidence for specific treatments. PLO is a transient and rare form of osteoporosis that affects women of childbearing age during the third trimester of pregnancy and post-partum. Though the pathophysiology of the PLO is poorly understood, several case series, case studies, and fewer cohort studies are available highlighting the role of pregnancy and lactation apart from conventional risk factors in the progression of PLO. Approximately 300 research and review articles related to PLO have been read from 1996 to 2023 which include several case studies, case series, cohort studies, meta-analyses, and narrative reviews from PubMed, Embase, Scopus, Google Scholar, World Health Organization regional databases. Common clinical manifestations include lower back and hip pain and rarely vertebral compression fractures. During pregnancy and lactation, women undergo reversible changes in mineral homeostasis and skeletal metabolism. Increased calcium absorption and urinary excretion during pregnancy and increased bone resorption along with renal calcium reabsorption in lactation are the main maternal metabolic adaptations that support the skeletal growth and development of the fetus and newborn respectively. Management of the PLO depends upon proper diagnosis and prognosis using biochemical bone turnover markers and bone histomorphometry. Conventional methods include calcium and vitamin D supplementation, giving up breastfeeding, physiotherapy, supportive braces, and bed rest. Bisphosphonates, denosumab, and teriparatide are commonly prescribed medications, assuring the recovery of bone mineral density besides certain side effects. Considering the transient nature, and underreporting of the cases, treatment recommendations should be personalized based on the parity, duration of lactation, presence or absence of fractures, societal status, age, ethnicity, and race.

Keywords

• osteoporosis
• pregnancy
• lactation
• pthrp
• prolactin
• teriparatide
• bisphosphonates