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Osteoporosis presenting in pregnancy, puerperium, and lactation

Kovacs, Christopher S.

Current Opinion in Endocrinology & Diabetes and Obesity: December 2014 - Volume 21 - Issue 6 - p 468–475
doi: 10.1097/MED.0000000000000102

Purpose of review To describe our current state of knowledge about the pathophysiology, incidence, and treatment of osteoporosis that presents during pregnancy, puerperium, and lactation.

Recent findings When vertebral fractures occur in pregnant or lactating women, it is usually unknown whether the skeleton was normal before pregnancy. Maternal adaptations increase bone resorption modestly during pregnancy but markedly during lactation. The net bone loss may occasionally precipitate fractures, especially in women who have underlying low bone mass or skeletal fragility prior to pregnancy. Bone mass and strength are normally restored postweaning. Transient osteoporosis of the hip is a sporadic disorder localized to one or both femoral heads; it is not due to generalized skeletal resorption. Anecdotal reports have used bisphosphonates, strontium ranelate, teriparatide, or vertebroplasty/kyphoplasty to treat postpartum vertebral fractures, but it is unclear whether these therapies had any added benefit over the spontaneous skeletal recovery that normally occurs after weaning.

Summary These relatively rare fragility fractures result from multifactorial causes, including skeletal disorders that precede pregnancy, and structural and metabolic stresses that can compromise skeletal strength during pregnancy and lactation. Further study is needed to determine when pharmacological or surgical therapy is warranted instead of conservative or expectant management.

Faculty of Medicine – Endocrinology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada

Correspondence to Dr Christopher S. Kovacs, MD, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL A1B 3V6, Canada. Tel: +1 709 777 6881; fax: +1 709 777 8049; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins