Osteoporosis can occur during pregnancy (gestational osteoporosis). Illustration: Anatomy & Physiology, Connexions Web site / Wikimedia. CC BY 3.0

Pregnancy and osteoporosis

Definition

Osteoporosis (osteoporosis) related to pregnancy and lactation is a rare but well-known condition. Most often, healthy women are affected during the last part of pregnancy or during the period when they are breastfeeding.

Disease Cause

• During pregnancy, the structure of the fetus skeletal requires that large amounts of calcium (lime) are transferred from the pregnant skeleton
• Milk production during breastfeeding drains the woman of calcium in addition to estrogen being low. It is estimated that women have 4-6% loss of bone mass during the first 6 months of breastfeeding (reference: Hopkinson JM, 2000)
• It is still unclear why some women develop severe osteoporosis related to pregnancy, but some are predisposed:
  • Genetic (hereditary) disposition
  • Lack of lime and Vitamin D
  • Use of heparin (blood thinning)
  • Low body weight
  • Unrecognized disease
    • Hyper-parathyroidism
    • High metabolism / thyrotoxicosis

Symptom

Suddenly, strong and persistent pain located to the spine in the last part of pregnancy or lactation

• The pain becomes worse by almost all kind of motion
• Vertebrae in the vertebral column and the lower back are most often attacked
• Pain in the chest can be caused by rib fractures

Medical examinations and diagnosis

• Larger fractures appear on radiographs
• MRI investigations of the spine is most accurate
• For bone density measurement (Dexa Scan) low bone density due to calcium deficiency can be detected
  • However, some have good bone density, but damaged structure (trabecler) in the bone tissue and subsequent fractures.

Treatment

• Calcium and vitamin D can be used throughout the pregnancy and during breastfeeding
• Alendronate tablets are often used for osteoporosis, but should not be used during pregnancy and lactation
• Teriparatide (Forsteo) may contribute to the development of the skeleton, but should not be used during pregnancy or lactation

Prognosis

New pregnancies occur in about one in three.

Literature

• Yun KY, 2017

• Bindevevssykdommer.no
• Vaskulitt.no