Recent Insights into Pregnancy and Lactation-Associated Osteoporosis (PLO)

Abstract

During pregnancy and lactation, female physiology adapts to fulfill the fetal and neonatal calcium and phosphorus requirements. The physiological changes that take place during these periods do not affect maternal skeleton resistance to fracture in most of the cases. However, there is a small percentage of women that do experience fragility fractures during these times of life. Pregnancy and lactation-associated osteoporosis (PLO) is an infrequent condition defined by the occurrence of non-traumatic fractures – most frequently vertebral – during the third trimester of gestation and/or the first months of postpartum. Its physiopathology has not yet been completely elucidated. Several authors have reported that risk factors for secondary osteoporosis might be present in up to 80% of the cases of PLO patients. According to recent studies, genetic factors might also play a relevant role in PLO. Given its rarity, the available literature on this condition is limited. Most of the published data consist on case reports and case series articles. There are not any randomized controlled trials regarding this disorder. Although there is consensus about discontinuation of lactation and calcium and vitamin D supplementation as the first steps in the treatment of these patients, there is still controversy regarding the long-term and/or pharmacological management of this condition. Recent data on the use of teriparatide in this population looks promising. In this review, we aimed to revise and summarize current knowledge about the physiopathology and management of PLO.

Molecular and Cellular Mechanisms of Osteoporosis

“…Studies of hormonal levels during pregnancy and lactation make it possible to study the dependence of calcitonin and parathyroid hormone on estrogen, but research data are contradictory. During the transition from pregnancy to lactation, the level of estrogen level decreases as well as parathyroid hormone increases, and calcitonin decreases to supply calcium to milk [31,32]. Calcitonin plays a key role in mineral metabolism during lactation and inhibits bone resorption by affecting the osteoclast cytoskeleton.…”

Features of the Physiology of the Postpartum Period After Caesarean Section

“…During the postpartum period, changes in all domains of the International Classification of Functioningstructure and function, activity, participation -can be detected in women. The physical and mental status of a woman directly affects her ability to care for and raise a child, return to work and social activity, as well as the quality of life, which is the degree of comfort of a person both within herself and within the environment, therefore, they require certain measures recovery for the fastest possible normalization [8,24].…”

Bilateral transient osteoporosis of the hip: a neglected cause of hip pain during pregnancy

“…During pregnancy and lactation, there is a higher demand for calcium and changes in maternal bone microarchitecture may occur, leading to a temporary reduction in skeletal strength. In pregnancy, calcium is primarily supplied by increased intestinal absorption, with minor contribution from maternal bone loss 1,2 . Whereas, during lactation, daily calcium loss in milk is mainly supported by maternal bone resorption.…”