Osteoporosis during Pregnancy

Osteoporosis is a condition in which human bone density decreases, which leads to a decrease in bone strength and increased risk of fractures. This condition often occurs in women during menopause. But sometimes it becomes a serious problem during pregnancy.

There is a condition called “osteoporosis associated with pregnancy,” in which a woman suffers from bone fractures without any apparent cause during pregnancy or within a few weeks after giving birth. More often, it is the fracture of vertebrae and femurs. Unlike postmenopausal osteoporosis, this disease is fairly benign. Despite the long-term pain, the woman eventually recovers completely.

During any pregnancy, the loss of bone mass in the spine and the femur is from 3 to 5%. Bone loss during lactation is even more significant, ranging from 3 to 10% when breastfeeding lasts from 3 to 6 months. In other words, if a young mom is breastfeeding for six months, her spine loses 10% of its original weight. There is a clear relationship between bone loss, the duration of breastfeeding, and lactation amenorrhea; prophylactic calcium supplementation does not prevent this process.

Childbirth and pregnancy make the lack of calcium obvious. It is necessary to take multivitamins with magnesium and calcium, undergo densitometry, and see the bone density. Many women have similar problems after childbirth; they may get injured by accident, and after an X-ray they are said their bones are too porous; so they are advised to drink calcium.

It is believed that hormones during breastfeeding (relative estrogen deficiency and a large amount of the prolactin hormone) promote mobilization (extraction) of calcium from women’s bones to meet the needs of the baby. The recovery period for bones after breastfeeding may take 18 months or longer. That is why there is the concept of “intense childbearing function” when the interval between births is quite small (from a few months to 1.5 years). During this period, the female body is simply unable to recover what it “lost” during the previous pregnancy, and it dramatically increases the risk of complications during pregnancy and childbirth.

Osteoporosis, associated with pregnancy and lactation, is a rare disease. It is based on a strong genetic component (a family history where serious problems with the bone tissue have occurred earlier, and it is likely that a woman’s bone density is already different from the normal one at the beginning of pregnancy). Different medications that a pregnant woman is forced to take for a long time serve as an aggravating factor. For example, this is the injection of low molecular weight heparin in case of antiphospholipid syndrome or other thrombophilia. In such situations, the risk of miscarriage and baby loss outweighs the potential risk of osteoporosis and related fractures, but these risks must always be discussed with your doctor.

This condition is more common during first pregnancies. The good news is that the disease recurrence in subsequent pregnancies is usually not observed. Bone condition automatically (without any treatment) is restored within a few years after birth, but there may be implications and related fractures because the structure of the spine will never restore its original shape.

Osteoporosis cannot be suspected before a fracture has occurred; it is also impossible to carry out diagnostic tests (such as X-rays) during pregnancy because of the danger of complications for the baby. Therefore, the diagnosis is established after birth based on the history of clinical fractures, X-ray studies and bone densitometry (bone density measurement).

The best treatment includes rest and painkillers when the pain intensity is high. Many doctors advise to stop breastfeeding because, as it has been said, lactation promotes “washing out” calcium from the bones, even with the additional intake of calcium and vitamin D. In any case, refusing to breastfeed is a very personal question and requires a balanced approach. It is recommended to conduct certain complexes of physical exercises under the supervision of a medical specialist; swimming is highly recommended.