Pregnancy- and lactation-induced osteoporosis: a social-media-based survey

Abstract

Background Pregnancy- and lactation-induced osteoporosis (PLO) presenting as spinal fractures is rare, and the spectrum of clinical presentation, risk factors and pathophysiology are incompletely understood. The aim of this study was to delineate clinical parameters, risk factors and osteoporosis-related quality of life (QOL) of women with PLO. Methods Participants of a social-media (WhatsApp) PLO group and mothers of a parents’ WhatsApp group (control group) were offered to fill a questionnaire, including an osteoporosis-related QOL section. The groups were compared using the independent Students t test for numerical variables, and the Chi-square test or Fisher’s exact test for categorical variables. Results Twenty-seven women with PLO and 43 in the control group (aged 36.2 ± 4.7 and 38.8 ± 4.3 years, respectively, p = 0.04) participated. Among women with PLO, more than 5 vertebrae were involved in 13 (48%), 4 vertebrae in 6 (22%), and 3 or fewer vertebrae in 8 (30%). Among the 24 women with relevant data, 21 (88%) had nontraumatic fractures; 3 (13%) women had fractures during pregnancy, and the remaining during the early postpartum period. Diagnosis was delayed for over 16 weeks for 11 (41%) women; 16 (67%) received teriparatide. Significantly lower proportions of women in the PLO group engaged in physical activity over 2 hours/week, before and during pregnancy (37 vs. 67%, p < 0.015 and 11 vs. 44%, p < 0.003, respectively). A lower proportion of the PLO than the control group reported calcium supplementation during pregnancy (7% vs. 30%, p = 0.03) and a higher proportion reported treatment with low-molecular-weight-heparin during pregnancy (p = 0.03). Eighteen (67%) of the PLO group expressed fear of fractures and 15 (56%) fear of falls, compared to none and 2%, respectively, of the control group (p < 0.00001 for both). Conclusions Most of the women with PLO who responded to our survey reported spinal fractures involving multiple vertebrae, delayed diagnosis, and treatment with teriparatide. Compared to a control group, they reported less physical activity and impaired QOL. For this uncommon yet severe condition, a multidisciplinary effort should be exerted for early identification and treatment, to alleviate back pain, prevent subsequent fractures and improve QOL.

Pregnancy and lactation-associated osteoporosis as a major type of premenopausal osteoporosis: a retrospective cohort study based on real-world data

“…Our results were similar to those of a recent systematic review showing that PLO occurs most frequently in the first 3 months after childbirth [ 14 ], but different with regard to the frequency later than 3 months after childbirth, which was 51.1% (24/47) in our study and 4.9% (4/82) in theirs. A very recent survey of PLO showed that more than one-fifth of vertebral fractures occurred later than 12 weeks after childbirth [ 15 ]. One explanation is that a systematic review investigating case reports and series would easily miss underlying patients in whom the physicians had no interest.…”

“…Vertebral fractures during the late pregnancy and early postpartum periods have been the most typically described outcome of PLO, although other fractures are possible [ 9 , 12 , 13 ]. Nevertheless, a recent systematic review, as well as a recent social media survey of PLO, investigated only vertebral fractures [ 14 , 15 ]. In Japan, a few epidemiological studies of osteoporosis in young women have recently been published [ 13 , 16 ], but it is difficult to identify the occurrence of fragility fractures without major trauma in large populations with high anonymity.…”