Osteoporosis

INFORMATION FOR WOMEN WHO HAVE OSTEOPOROSIS DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is osteoporosis during pregnancy?

Osteoporosis is a condition in which the density of mineral content in bones is below normal. This means that the strength of bones is below normal, which puts you at elevated risk of fractures throughout the body, but especially high weight-bearing areas, such as the hip and spine. Osteoporosis typically is an issue for post-menopausal women, because the decrease in the amount of estrogen in your body enables bone-eating cells called osteoclasts to live longer, so bone mineral is destroyed at an accelerated rate. Although a phenomenon called pregnancy lactation osteoporosis (PLO) has been reported to occur during the third trimester and after delivery, only a very small number of cases have been documented, so the main concern about osteoporosis during pregnancy and lactation is the fact that this is a time when there is a particularly high demand for calcium from your body to support the babys developing skeletal system. Consequently, you have a substantial requirement for vitamin D and calcium.

How common is osteoporosis during pregnancy?

PLO is extremely rare, with only approximately 100 cases reported in the literature. On the other hand, while the prevalence of osteoporosis in women in their fifties and higher varies in reports, the prevalence is overall very high. Hundreds of millions of women are estimated to be affected, and the condition is thought to be under-diagnosed. Numerous factors can elevate your risk of developing osteoporosis. First of all, since strong muscles lead to strong bone, people who are lightweight or who lack weight-bearing exercise are at particularly high risk. Studies on astronauts have demonstrated a loss of 1-2 percent of bone density for every month spent in weightlessness, a finding that translates well for people on Earth who are on bed rest. What this means for you is that exercise can greatly change your risk of developing either osteoporosis or osteopenia (a kind of pre-osteoporosis, characterized by decreased bone density, not to the point that we can all it osteoporosis). Women of Caucasian and Asian background have an elevated risk compared with women of African descent, due both to differences in estrogen levels and weight. Corticosteroid medication (such as for asthma or autoimmune disease) and epilepsy medication, particularly phenytoin, also promote loss of bone density, as does smoking. Probably, smoking by itself is not enough to be a primary cause of osteoporosis, but it can help push you into osteoporosis, if your bones are already losing bone mineral density, due to decreasing levels of estrogen, inadequate exercise, inadequate vitamin D, or a gastrointestinal condition that keeps you from absorbing various nutrients.   

How is osteoporosis during pregnancy diagnosed?

Osteoporosis is diagnosed with a special type of X-ray imaging called dual X-ray absorptiometry (DEXA) scanning. There is a tendency among health practitioners to avoid DEXA in pregnant women, due to an unfounded fear of low dose radiation in society, along with fears of potential lawsuits. However, while the dose of ionizing radiation from a DEXA varies widely depending on how much of the body is scanned, it is always measured in microsieverts (µSv)3, meaning that it is exquisitely low. From the natural background radiation on Earth, the average pregnant woman in the United States receives hundreds of times such a dose when living at sea level, or hundreds to thousands of times such a dose for those in high altitude cities, such as Denver or Salt Lake City, with no harmful effects to the fetus; thats without any medical procedures and without flying on any aircraft. Consequently, if you have suffered from unexplained fractures, or have a family history of osteoporosis beginning at a young age, it is reasonable to ask your doctor for a DEXA scan.

In DEXA, the result, known as a T-score, is given as a negative number, such that the more negative the score, the lower the bone density. A DEXA score between zero and -1.0 is considered normal bone density. A T-score of -1.0 to -2.5 indicates osteopenia, meaning low bone density, while a T-score of -2.5 or lower means osteoporosis.

In addition to DEXA scanning, doctors will also get a blood sample for a comprehensive metabolic panel (CMP, also called a CHEM-14), and a complete blood count (CBC), plus levels of parathyroid hormone (PTH), looking for potential underlying causes of bone mineral loss.

Does osteoporosis cause problems during pregnancy?

Osteoporosis can cause you to suffer a bone fracture from small falls or other actions that otherwise would not be enough to cause a fracture. Such fractures can occur in particularly critical locations, such as the hip and spine. If this happens during pregnancy, you may be better off delivering with a cesarean section to avoid strain on the pelvic bones.

Does osteoporosis cause problems for the baby?

As noted earlier, osteoporosis during pregnancy is extremely rare. However, osteoporosis during pregnancy will not have any direct impact on the baby. Your body will continue drawing a supply of calcium and phosphate from your bones to support the needs of the fetal skeleton. If you attempt to nurse after you deliver, this process will accelerate.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the osteoporosis
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat osteoporosis during pregnancy?

Osteoporosis and osteopenia are treated with a group of medications called bisphosphonates (BPs). When taken orally, these drugs can cause esophagitis (inflammation of the esophagus) and other problems that potentially can lead ultimately to esophageal cancer. Consequently, if you take BPs, you need to follow the pill with a full glass of water and remain standing for at least 30 minutes. On the other hand, if you choose to have the medication injected, you can avoid the esophageal risks. BPs cross the placenta, and there is some concern about their safety in pregnancy. Still, the concerns are based only on laboratory animal studies using doses much higher than what you would receive for osteoporosis. Consequently, the question of whether to take these drugs during pregnancy is a matter of weighing benefits against risks. Additionally, you should be taking vitamin D and calcium supplements during pregnancy.

Who should NOT stop taking medication for osteoporosis during pregnancy?

The issue of stopping BPs is one that should be discussed between you and your doctor. There is little reason to stop taking vitamin D and calcium unless you happen to develop a rare complication of excessive calcium intake, called milk-alkali syndrome.

What should I know about choosing a medication for my osteoporosis during pregnancy?

It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.

You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources list
ed below.

What should I know about taking a medication for my osteoporosis when I am breastfeeding?

Very little is known about BPs in nursing mothers because very few women are taking these drugs prior to menopause. If you have a rare case of PLO, however, it may not be wise to nurse, since the production of breastmilk draws an enormous amount of calcium, which will exacerbate your condition. In such cases, you will likely be better off choosing one of the excellent infant formulas on the market.

What alternative therapies besides medications can I use to treat my osteoporosis during pregnancy?

Regular exercise that includes weight-bearing, high impact activity is an excellent way to promote bone density. It is also important to get adequate amounts of vitamin D and calcium. It is possible to get enough calcium from your diet, and sunlight does provide you with vitamin D, but during pregnancy, it is virtually impossible to get enough vitamin D without vitamin D supplements.

What can I do for myself and my baby when I have osteoporosis during pregnancy?

Follow the instructions of your physician, nutritionists, and other health care providers who are working with you.

Resources for osteoporosis in pregnancy:

For more information about osteoporosis during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

Read the whole report
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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