Pregnancy-associated osteoporosis: a UK case series and literature review
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.
KeywordsFractures 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.
- 11.Compston J (2013) Skeletal effects of drugs. In: Rosen CJ (ed) Primer on the metabolic bone diseases and disorders of mineral metabolism, 8th edn. John Wiley & Sons, HobokenGoogle Scholar
- 20.Zarattini G, Buffoli P, Isabelli G, Marchese M (2014) Pregnancy-associated osteoporosis with seven vertebral compression fractures, a case treated with strontium ranelate. Clin Cases Miner Bone Metab 11:139–141Google Scholar