Pregnancy-associated osteoporosis: a UK case series and literature review

  • S.A. HardcastleEmail author
  • F. Yahya
  • A.K. Bhalla
Review Article


Mini Abstract: Pregnancy-associated osteoporosis (PAO) is a rare syndrome affecting women during late pregnancy and the early postpartum period. We set out to review the clinical features of ten cases of PAO from a single UK centre. Patients had attended the Royal National Hospital for Rheumatic Diseases, Bath (RNHRD) between January 2000 and June 2016. The principal criterion for inclusion was the occurrence of low trauma fractures either during pregnancy or the immediate post-partum period. Data were obtained from retrospective review of medical notes. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (Hologic ®Discovery system) at the lumbar spine and hip. Data pertaining to the pregnancy, as well as type and duration of treatment received, were reviewed. All ten cases presented with vertebral fractures. In four patients, no risk factors for fracture other than pregnancy or breastfeeding could be identified. Four patients were found to have vitamin D insufficiency at the time of diagnosis, and a further two patients had received treatment with low molecular weight heparin (LMWH). In one case, further investigation led to a diagnosis of osteogenesis imperfecta (OI) confirmed on genetic testing. In terms of treatment, eight out of the ten patients in this series received a bisphosphonate, most commonly risedronate due to its relatively short skeletal retention time. Clinicians should be aware of PAO, a rare but recognised complication of pregnancy. The condition should be especially considered in women presenting with new onset back pain in pregnancy or the postpartum period.


Fractures Osteoporosis Pregnancy 


Compliance with ethical standards

Conflicts of interest

SH has received conference fee support from Lilly UK. FY has received funding for attending congresses and speaker fees from Pfizer, Novartis and Abbvie and grant/advisory board for Novartis. The other authors declare that they have no conflict of interest.

Supplementary material

198_2019_4842_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 14.3 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Royal National Hospital for Rheumatic DiseasesBathUK
  2. 2.Department of MedicineUniversity of MalayaKuala LumpurMalaysia

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