Osteoporosis International

, Volume 28, Issue 4, pp 1393–1399 | Cite as

Pregnancy-associated osteoporosis: a case-control study

  • P. Hadji
  • J. Boekhoff
  • M. Hahn
  • L. Hellmeyer
  • O. Hars
  • I. Kyvernitakis
Original Article



The etiology and underlying mechanisms of pregnancy-associated osteoporosis (PAO) are still unknown, since no systematic analyses exist. Our results indicate that PAO is a heterogeneous, rare but severe disease including a substantial number of fractures with a significant delay from first symptom to diagnose.


Pregnancy-associated osteoporosis (PAO) is a rare but severe type of premenopausal osteoporosis. Most common symptom includes acute lower back pain due to vertebral fracture predominantly occurring in the last trimester of pregnancy or immediately postpartum. The exact underlining mechanisms and risk factors of PAO are still unknown, and up to date, there are no published systematic analyses.


We identified 102 PAO patients and matched them with 102 healthy controls according to age, region, and gravidity to evaluate risk factors in a large and homogenous population of women.


The baseline characteristics and anthropometric data of the two study groups were similar. Eighty-eight percent of the patients with PAO suffered from one or more fractures with a mean of 3.3 fractures per patient. The most common fracture site was the thoracolumbar spine, whereas 29, 37, 48, and 35% of the patients reported fractures at TH11, TH12, L1, and L2, respectively. PAO patients suffered more frequently from excessive dental problems in childhood (p < 0.001). The control group performed significantly more frequently sports both before (p < 0.002) and after puberty (p < 0.01). Compared to the controls, the patients with PAO reported twice as often severe diseases during pregnancy (p < 0.029). Hereby, the frequency of immobilization was twice as often in the PAO group compared to that in the control group (p < 0.005).


Our results indicate that PAO is a heterogeneous, rare but severe disease including a substantial number of fractures with a significant delay from first symptom to diagnose. Increased awareness is warranted to immediately start effective treatment.


Pregancy associated osteoporosis Fracture risk Risk factors 


Compliance with ethical standards

The local ethics committee of the Philipps-University of Marburg approved the study. All patients provided written informed consent prior to participation according to the declaration of Helsinki and the German law.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • P. Hadji
    • 1
    • 2
  • J. Boekhoff
    • 3
  • M. Hahn
    • 3
  • L. Hellmeyer
    • 4
  • O. Hars
    • 5
  • I. Kyvernitakis
    • 2
    • 6
  1. 1.Department of Bone Oncology, Gynecological Endocrinology and Reproductive Medicine, German Reference Centre for Pregnancy-Associated OsteoporosisNordwest Hospital of the Goethe-University of FrankfurtFrankfurt a. MGermany
  2. 2.Faculty of MedicinePhilipps-University of MarburgMarburgGermany
  3. 3.Department of Obstetrics and GynecologyPhilipps-University of MarburgMarburgGermany
  4. 4.Department of Obstetrics and GynecologyVivantes Klinikum FriedrichshainBerlinGermany
  5. 5.Statistical Institute Dr. HarsBerlinGermany
  6. 6.Department of Obstetrics and GynecologyBuergerhospital of the Goethe-University of FrankfurtFrankfurtGermany

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