Fractures for Females: Pregnancy-Associated Osteoporosis

On my son’s due date, I ran 5 miles (as I often did during my pregnancy), hoping he would be a New Year’s baby. The thought of low bone density never crossed my mind, even living in Seattle where the sun only intermittently showers people with Vitamin D. However, bone mineral density changes do occur over the course of carrying a fetus through the finish line of birth. And sometimes women experience a relatively rare condition referred to as pregnancy-related osteoporosis.

Krishnakumar, Kumar, and Kuzhimattam²⁰¹⁶ explored vertebral compression fracture due to pregnancy-related osteoporosis (PAO). The condition was first described over 60 years ago, and risk factors include low body mass index, physical inactivity, low calcium intake, family history, and poor nutrition. Of 535 osteoporotic fractures considered, 2 were secondary to PAO. A 27-year-old woman complained of back pain during her 8th month of pregnancy, and 3 months postpartum, she was found to have a T10 compression fracture. A 31-year-old with scoliosis had back pain at 1 month postpartum but did not seek treatment until 5 months after giving birth, and she had T12, L1, and L2 compression fractures. The women were treated with the following interventions: cessation of breastfeeding, oral calcium 100 mg/day, Vitamin D 800 IU/day, alendronate 70 mg/week, and thoracolumbar orthosis. Bone density improved significantly, and no new fractures developed during the 2-year follow up period.

Nakamura et al.²⁰¹⁵ reviewed literature on pregnancy-and-lactation-associated osteoporosis, focusing on 2 studies. The authors explained symptoms of severe low back, hip, and lower extremity joint pain that occur postpartum or in the 3rd trimester of pregnancy can be secondary to this disorder, but it is often not considered immediately. A 30-year-old woman with such debilitating pain in her spine with movement 2 months postpartum had to stop breastfeeding, and 10 months later, she was found to have 12 vertebral fractures. She had low bone mineral density (BMD) in her lumbar spine, and she was given 0.5mg/day alfacalcidol (ALF), an active vitamin D3 analog, as well as Vitamin K. No more fractures developed over the next 6 years. A 37-year-old female had severe back pain 2 months postpartum, and at 7 months was found to have 8 vertebral fractures due to PAO. Her pain subsided after stopping breastfeeding, using a lumbar brace, and supplementing with 0.5mg/day ALF and Vitamin K. The authors concluded goals for treating PAO include preventing vertebral fractures and increasing BMD and overall fracture resistance with Vitamins D and K.

Other treatment approaches for similar case presentations have been published. One gave credit to denosumab injections giving pain relief and improved BMD to 2 women, ages 35 and 33, after postpartum vertebral fractures (Sanchez, Zanchetta, & Danilowicz²⁰¹⁶). Guardio and Fiore²⁰¹⁶ reported success using the amino-bisphosphonates, neridronate, in a 38-year-old with PAO T4 fracture.

Thankfully for these women experiencing PAO vertebral fractures, supplements boosted their BMD and prevented further fractures. However, they all had to prematurely stop breastfeeding to reduce their pain as well. This rare condition can be used as a warning for women to proactively increase their BMD. The course, Meeks Method for Osteoporosis, can help therapists implement safe, effective, and active ways to promote bone health for all - especially the pregnant population in serious need of support.

Krishnakumar, R., Kumar, A. T., & Kuzhimattam, M. J. (2016). Spinal compression fractures due to pregnancy-associated osteoporosis. Journal of Craniovertebral Junction & Spine, 7(4), 224–227. http://doi.org/10.4103/0974-8237.193263
Nakamura, Y., Kamimura, M., Ikegami, S., Mukaiyama, K., Komatsu, M., Uchiyama, S., & Kato, H. (2015). A case series of pregnancy- and lactation-associated osteoporosis and a review of the literature. Therapeutics and Clinical Risk Management, 11, 1361–1365. http://doi.org/10.2147/TCRM.S87274
Sánchez, A., Zanchetta, M. B., & Danilowicz, K. (2016). Two cases of pregnancy- and lactation- associated osteoporosis successfully treated with denosumab. Clinical Cases in Mineral and Bone Metabolism, 13(3), 244–246. http://doi.org/10.11138/ccmbm/2016.13.3.244
Gaudio, A., & Fiore, C. E. (2016). Successful neridronate therapy in pregnancy-associated osteoporosis. Clinical Cases in Mineral and Bone Metabolism, 13(3), 241–243. http://doi.org/10.11138/ccmbm/2016.13.3.241