Skip to main content
SpringerLink
Log in

Presentation and management of osteoporosis presenting in association with pregnancy or lactation

Osteoporosis International volume 26, pages 2223–2241 (2015)Cite this article

Abstract

In this review, we summarize our current understanding of the pathophysiology of fragility fractures that occur for the first time during pregnancy and lactation, and provide guidance on appropriate investigations and treatment strategies. Most affected women will have had no prior bone density reading, and so the extent of bone loss that may have occurred during pregnancy or lactation is uncertain. During pregnancy, intestinal calcium absorption doubles in order to meet the fetal demand for calcium, but if maternal intake of calcium is insufficient to meet the combined needs of the mother and baby, the maternal skeleton will undergo resorption during the third trimester. During lactation, several hormonal changes, independent of maternal calcium intake, program a 5–10 % loss of trabecular mineral content in order to provide calcium to milk. After weaning the baby, the maternal skeleton is normally restored to its prior mineral content and strength. This physiological bone resorption during reproduction does not normally cause fractures; instead, women who do fracture are more likely to have additional secondary causes of bone loss and fragility. Transient osteoporosis of the hip may affect one or both femoral heads during pregnancy but it involves localized edema and not skeletal resorption. Case reports have described the use of calcitonin, bisphosphonates, strontium ranelate, teriparatide, vertebroplasty, and kyphoplasty to treat post-partum vertebral fractures. However, the need for such treatments is uncertain given that a progressive increase in bone mass subsequently occurs in most women who present with a fracture during pregnancy or lactation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Givens MH, Macy IC (1933) The chemical composition of the human fetus. J Biol Chem 102:7–17

    CAS  Google Scholar 

  2. Comar CL (1956) Radiocalcium studies in pregnancy. Ann N Y Acad Sci 64:281–298

    CAS  Google Scholar 

  3. Kovacs CS (2014) Bone development and mineral homeostasis in the fetus and neonate: roles of the calciotropic and phosphotropic hormones. Physiol Rev 94(4):1143–1218. doi:10.1152/physrev.00014.2014

    CAS  PubMed  Google Scholar 

  4. Kovacs CS, Kronenberg HM (1997) Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation. Endocr Rev 18(6):832–872. doi:10.1210/edrv.18.6.0319

    CAS  PubMed  Google Scholar 

  5. Kovacs CS (2011) Calcium and bone metabolism disorders during pregnancy and lactation. Endocrinol Metab Clin North Am 40(4):795–826. doi:10.1016/j.ecl.2011.08.002

    CAS  PubMed  Google Scholar 

  6. Heaney RP, Skillman TG (1971) Calcium metabolism in normal human pregnancy. J Clin Endocrinol Metab 33(4):661–670. doi:10.1210/jcem-33-4-661

    CAS  PubMed  Google Scholar 

  7. Kovacs CS (2014) The role of PTHrP in regulating mineral metabolism during pregnancy, lactation, and fetal/neonatal development. Clin Rev Bone Mineral Metabol 12(3):142–164. doi:10.1007/s12018-014-9157-6

    CAS  Google Scholar 

  8. Wasserman RH, Comar CL, Nold MM, Lengemann FW (1957) Placental transfer of calcium and strontium in the rat and rabbit. Am J Physiol 189(1):91–97

    CAS  PubMed  Google Scholar 

  9. Kovacs CS (2012) The role of vitamin D in pregnancy and lactation: insights from animal models and clinical studies. Ann Rev Nutr 32:9.1–9.27. doi:10.1146/annurev-nutr-071811-150742

    Google Scholar 

  10. Bikle DD, Gee E, Halloran B, Haddad JG (1984) Free 1,25-dihydroxyvitamin D levels in serum from normal subjects, pregnant subjects, and subjects with liver disease. J Clin Invest 74(6):1966–1971. doi:10.1172/JCI111617

    CAS  PubMed Central  PubMed  Google Scholar 

  11. Halloran BP, DeLuca HF (1980) Calcium transport in small intestine during pregnancy and lactation. Am J Physiol 239:E64–E68

    CAS  PubMed  Google Scholar 

  12. Brommage R, Baxter DC, Gierke LW (1990) Vitamin D-independent intestinal calcium and phosphorus absorption during reproduction. Am J Physiol 259:G631–G638

    CAS  PubMed  Google Scholar 

  13. Fudge NJ, Kovacs CS (2010) Pregnancy up-regulates intestinal calcium absorption and skeletal mineralization independently of the vitamin D receptor. Endocrinology 151(3):886–895. doi:10.1210/en.2009-1010

    CAS  PubMed  Google Scholar 

  14. Halloran BP, DeLuca HF (1980) Skeletal changes during pregnancy and lactation: the role of vitamin D. Endocrinology 107:1923–1929

    CAS  PubMed  Google Scholar 

  15. Purdie DW, Aaron JE, Selby PL (1988) Bone histology and mineral homeostasis in human pregnancy. Br J Obstet Gynaecol 95(9):849–854

    CAS  PubMed  Google Scholar 

  16. Moller UK, Við Streym S, Mosekilde L, Rejnmark L (2012) Changes in bone mineral density and body composition during pregnancy and postpartum. A controlled cohort study. Osteoporos Int 23(4):1213–1223. doi:10.1007/s00198-011-1654-6

    CAS  PubMed  Google Scholar 

  17. To WW, Wong MW (2011) Changes in bone mineral density of the os calcis as measured by quantitative ultrasound during pregnancy and 24 months after delivery. Aust N Z J Obstet Gynaecol 51(2):166–171. doi:10.1111/j.1479-828X.2010.01266.x

    PubMed  Google Scholar 

  18. Khosla S, van Heerden JA, Gharib H, Jackson IT, Danks J, Hayman JA, Martin TJ (1990) Parathyroid hormone-related protein and hypercalcemia secondary to massive mammary hyperplasia. N Engl J Med 322(16):1157. doi:10.1056/NEJM199004193221613

    CAS  PubMed  Google Scholar 

  19. Jackson IT, Saleh J, van Heerden JA (1989) Gigantic mammary hyperplasia in pregnancy associated with pseudohyperparathyroidism. Plast Reconstr Surg 84(5):806–810

    CAS  PubMed  Google Scholar 

  20. Eller-Vainicher C, Ossola MW, Beck-Peccoz P, Chiodini I (2012) PTHrP-associated hypercalcemia of pregnancy resolved after delivery: a case report. Eur J Endocrinol 166(4):753–756. doi:10.1530/eje-11-1050

    CAS  PubMed  Google Scholar 

  21. Trotter M, Hixon BB (1974) Sequential changes in weight, density, and percentage ash weight of human skeletons from an early fetal period through old age. Anat Rec 179(1):1–18. doi:10.1002/ar.1091790102

    CAS  PubMed  Google Scholar 

  22. Kovacs CS (2005) Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia 10(2):105–118. doi:10.1007/s10911-005-5394-0

    PubMed  Google Scholar 

  23. Wysolmerski JJ (2010) Interactions between breast, bone, and brain regulate mineral and skeletal metabolism during lactation. Ann N Y Acad Sci 1192:161–169. doi:10.1111/j.1749-6632.2009.05249.x

    CAS  PubMed Central  PubMed  Google Scholar 

  24. Yamamoto M, Duong LT, Fisher JE, Thiede MA, Caulfield MP, Rosenblatt M (1991) Suckling-mediated increases in urinary phosphate and 3′,5′-cyclic adenosine monophosphate excretion in lactating rats: possible systemic effects of parathyroid hormone-related protein. Endocrinology 129(5):2614–2622. doi:10.1210/endo-129-5-2614

    CAS  PubMed  Google Scholar 

  25. Dobnig H, Kainer F, Stepan V, Winter R, Lipp R, Schaffer M, Kahr A, Nocnik S, Patterer G, Leb G (1995) Elevated parathyroid hormone-related peptide levels after human gestation: relationship to changes in bone and mineral metabolism. J Clin Endocrinol Metab 80(12):3699–3707. doi:10.1210/jcem.80.12.8530622

    CAS  PubMed  Google Scholar 

  26. Thiede MA (1989) The mRNA encoding a parathyroid hormone-like peptide is produced in mammary tissue in response to elevations in serum prolactin. Mol Endocrinol 3(9):1443–1447

    CAS  PubMed  Google Scholar 

  27. Ratcliffe WA, Thompson GE, Care AD, Peaker M (1992) Production of parathyroid hormone-related protein by the mammary gland of the goat. J Endocrinol 133:87–93

    CAS  PubMed  Google Scholar 

  28. Stiegler C, Leb G, Kleinert R, Warnkross H, Ramschak-Schwarzer S, Lipp R, Clarici G, Krejs GJ, Dobnig H (1995) Plasma levels of parathyroid hormone-related peptide are elevated in hyperprolactinemia and correlated to bone density status. J Bone Miner Res 10(5):751–759. doi:10.1002/jbmr.5650100512

    CAS  PubMed  Google Scholar 

  29. Kovacs CS, Chik CL (1995) Hyperprolactinemia caused by lactation and pituitary adenomas is associated with altered serum calcium, phosphate, parathyroid hormone (PTH), and PTH-related peptide levels. J Clin Endocrinol Metab 80(10):3036–3042. doi:10.1210/jcem.80.10.7559893

    CAS  PubMed  Google Scholar 

  30. Rabbani SA, Khalili P, Arakelian A, Pizzi H, Chen G, Goltzman D (2005) Regulation of parathyroid hormone-related peptide by estradiol: effect on tumor growth and metastasis in vitro and in vivo. Endocrinology 146(7):2885–2894. doi:10.1210/en.2005-0062

    CAS  PubMed  Google Scholar 

  31. VanHouten J, Dann P, McGeoch G, Brown EM, Krapcho K, Neville M, Wysolmerski JJ (2004) The calcium-sensing receptor regulates mammary gland parathyroid hormone-related protein production and calcium transport. J Clin Invest 113(4):598–608. doi:10.1172/JCI18776

    CAS  PubMed Central  PubMed  Google Scholar 

  32. Ardeshirpour L, Dann P, Pollak M, Wysolmerski J, VanHouten J (2006) The calcium-sensing receptor regulates PTHrP production and calcium transport in the lactating mammary gland. Bone 38(6):787–793. doi:10.1016/j.bone.2005.11.009

    CAS  PubMed  Google Scholar 

  33. Bucht E, Telenius-Berg M, Lundell G, Sjoberg HE (1986) Immunoextracted calcitonin in milk and plasma from totally thyroidectomized women. evidence of monomeric calcitonin in plasma during pregnancy and lactation. Acta Endocrinol (Copenh) 113:529–535

    CAS  Google Scholar 

  34. Woodrow JP, Sharpe CJ, Fudge NJ, Hoff AO, Gagel RF, Kovacs CS (2006) Calcitonin plays a critical role in regulating skeletal mineral metabolism during lactation. Endocrinology 147(9):4010–4021. doi:10.1210/en.2005-1616

    CAS  PubMed  Google Scholar 

  35. Woodrow JP (2009) Calcitonin modulates skeletal mineral loss during lactation through interactions in mammary tissue and directly though osteoclasts in bone [PhD thesis]. PhD, Memorial University of Newfoundland, St. John’s, Newfoundland

  36. Ren Y, Chien J, Sun YP, Shah GV (2001) Calcitonin is expressed in gonadotropes of the anterior pituitary gland: its possible role in paracrine regulation of lactotrope function. J Endocrinol 171(2):217–228

    CAS  PubMed  Google Scholar 

  37. Yuan R, Kulkarni T, Wei F, Shah GV (2005) Targeted overexpression of calcitonin in gonadotrophs of transgenic mice leads to chronic hypoprolactinemia. Mol Cell Endocrinol 229(1–2):193–203

    CAS  PubMed  Google Scholar 

  38. Tohei A, VandeGarde B, Arbogast LA, Voogt JL (2000) Calcitonin inhibition of prolactin secretion in lactating rats: mechanism of action. Neuroendocrinology 71(5):327–332

    CAS  PubMed  Google Scholar 

  39. Colaianni G, Di Benedetto A, Zhu LL, Tamma R, Li J, Greco G, Peng Y, Dell’Endice S, Zhu G, Cuscito C, Grano M, Colucci S, Iqbal J, Yuen T, Sun L, Zaidi M, Zallone A (2011) Regulated production of the pituitary hormone oxytocin from murine and human osteoblasts. Biochem Biophys Res Commun 411(3):512–515. doi:10.1016/j.bbrc.2011.06.158

    CAS  PubMed  Google Scholar 

  40. Colaianni G, Sun L, Di Benedetto A, Tamma R, Zhu LL, Cao J, Grano M, Yuen T, Colucci S, Cuscito C, Mancini L, Li J, Nishimori K, Bab I, Lee HJ, Iqbal J, Young WS 3rd, Rosen C, Zallone A, Zaidi M (2012) Bone marrow oxytocin mediates the anabolic action of estrogen on the skeleton. J Biol Chem 287(34):29159–29167. doi:10.1074/jbc.M112.365049

    CAS  PubMed Central  PubMed  Google Scholar 

  41. Hernandez LL, Gregerson KA, Horseman ND (2012) Mammary gland serotonin regulates parathyroid hormone-related protein and other bone-related signals. Am J Physiol Endocrinol Metab 302(8):E1009–E1015. doi:10.1152/ajpendo.00666.2011

    CAS  PubMed Central  PubMed  Google Scholar 

  42. Horseman ND, Hernandez LL (2014) New concepts of breast cell communication to bone. Trends Endocrinol Metab 25(1):34–41. doi:10.1016/j.tem.2013.08.004

    CAS  PubMed  Google Scholar 

  43. VanHouten JN, Dann P, Stewart AF, Watson CJ, Pollak M, Karaplis AC, Wysolmerski JJ (2003) Mammary-specific deletion of parathyroid hormone-related protein preserves bone mass during lactation. J Clin Invest 112(9):1429–1436. doi:10.1172/JCI19504

    CAS  PubMed Central  PubMed  Google Scholar 

  44. Ardeshirpour L, Brian S, Dann P, VanHouten J, Wysolmerski J (2010) Increased PTHrP and decreased estrogens alter bone turnover but do not reproduce the full effects of lactation on the skeleton. Endocrinology 151(12):5591–5601. doi:10.1210/en.2010-0566

    CAS  PubMed Central  PubMed  Google Scholar 

  45. VanHouten JN, Wysolmerski JJ (2003) Low estrogen and high parathyroid hormone-related peptide levels contribute to accelerated bone resorption and bone loss in lactating mice. Endocrinology 144(12):5521–5529. doi:10.1210/en.2003-0892

    CAS  PubMed  Google Scholar 

  46. Kirby BJ, Ardeshirpour L, Woodrow JP, Wysolmerski JJ, Sims NA, Karaplis AC, Kovacs CS (2011) Skeletal recovery after weaning does not require PTHrP. J Bone Miner Res 26(6):1242–1251. doi:10.1002/jbmr.339

    CAS  PubMed Central  PubMed  Google Scholar 

  47. Kirby BJ, Ma Y, Martin HM, Buckle Favaro KL, Karaplis AC, Kovacs CS (2013) Upregulation of calcitriol during pregnancy and skeletal recovery after lactation do not require parathyroid hormone. J Bone Miner Res 28(9):1987–2000. doi:10.1002/jbmr.1925

    CAS  PubMed  Google Scholar 

  48. Brommage R, DeLuca HF (1985) Regulation of bone mineral loss during lactation. Am J Physiol 248(2 Pt 1):E182–E187

    CAS  PubMed  Google Scholar 

  49. Teti A, Zallone A (2009) Do osteocytes contribute to bone mineral homeostasis? osteocytic osteolysis revisited. Bone 44(1):11–16. doi:10.1016/j.bone.2008.09.017

    CAS  PubMed  Google Scholar 

  50. Qing H, Ardeshirpour L, Pajevic PD, Dusevich V, Jahn K, Kato S, Wysolmerski J, Bonewald LF (2012) Demonstration of osteocytic perilacunar/canalicular remodeling in mice during lactation. J Bone Miner Res 27(5):1018–1029. doi:10.1002/jbmr.1567

    CAS  PubMed Central  PubMed  Google Scholar 

  51. Sowers M (1996) Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 11(8):1052–1060. doi:10.1002/jbmr.5650110803

    CAS  PubMed  Google Scholar 

  52. Chan GM, Slater P, Ronald N, Roberts CC, Thomas MR, Folland D, Jackson R (1982) Bone mineral status of lactating mothers of different ages. Am J Obstet Gynecol 144(4):438–441

    CAS  PubMed  Google Scholar 

  53. Chan GM, McMurry M, Westover K, Engelbert-Fenton K, Thomas MR (1987) Effects of increased dietary calcium intake upon the calcium and bone mineral status of lactating adolescent and adult women. Am J Clin Nutr 46(2):319–323

    CAS  PubMed  Google Scholar 

  54. Sowers MF, Hollis BW, Shapiro B, Randolph J, Janney CA, Zhang D, Schork A, Crutchfield M, Stanczyk F, Russell-Aulet M (1996) Elevated parathyroid hormone-related peptide associated with lactation and bone density loss. JAMA 276(7):549–554

    CAS  PubMed  Google Scholar 

  55. Shomali ME, Ross DS (1999) Hypercalcemia in a woman with hypoparathyroidism associated with increased parathyroid hormone-related protein during lactation. Endocr Pract 5(4):198–200. doi:10.4158/EP.5.4.198

    CAS  PubMed  Google Scholar 

  56. Caplan RH, Beguin EA (1990) Hypercalcemia in a calcitriol-treated hypoparathyroid woman during lactation. Obstet Gynecol 76(3 Pt 2):485–489

    CAS  PubMed  Google Scholar 

  57. Cross NA, Hillman LS, Allen SH, Krause GF (1995) Changes in bone mineral density and markers of bone remodeling during lactation and postweaning in women consuming high amounts of calcium. J Bone Miner Res 10(9):1312–1320. doi:10.1002/jbmr.5650100907

    CAS  PubMed  Google Scholar 

  58. Kalkwarf HJ, Specker BL, Bianchi DC, Ranz J, Ho M (1997) The effect of calcium supplementation on bone density during lactation and after weaning. N Engl J Med 337(8):523–528. doi:10.1056/NEJM199708213370803

    CAS  PubMed  Google Scholar 

  59. Kolthoff N, Eiken P, Kristensen B, Nielsen SP (1998) Bone mineral changes during pregnancy and lactation: a longitudinal cohort study. Clin Sci (Lond) 94(4):405–412

    CAS  Google Scholar 

  60. Polatti F, Capuzzo E, Viazzo F, Colleoni R, Klersy C (1999) Bone mineral changes during and after lactation. Obstet Gynecol 94(1):52–56

    CAS  PubMed  Google Scholar 

  61. Prentice A (2000) Calcium in pregnancy and lactation. Annu Rev Nutr 20:249–272. doi:10.1146/annurev.nutr.20.1.249

    CAS  PubMed  Google Scholar 

  62. Prentice A, Jarjou LM, Cole TJ, Stirling DM, Dibba B, Fairweather-Tait S (1995) Calcium requirements of lactating Gambian mothers: effects of a calcium supplement on breast-milk calcium concentration, maternal bone mineral content, and urinary calcium excretion. Am J Clin Nutr 62(1):58–67

    CAS  PubMed  Google Scholar 

  63. Prentice A, Jarjou LM, Stirling DM, Buffenstein R, Fairweather-Tait S (1998) Biochemical markers of calcium and bone metabolism during 18 months of lactation in Gambian women accustomed to a low calcium intake and in those consuming a calcium supplement. J Clin Endocrinol Metab 83(4):1059–1066. doi:10.1210/jcem.83.4.4737

    CAS  PubMed  Google Scholar 

  64. Prentice A, Yan L, Jarjou LM, Dibba B, Laskey MA, Stirling DM, Fairweather-Tait S (1997) Vitamin D status does not influence the breast-milk calcium concentration of lactating mothers accustomed to a low calcium intake. Acta Paediatr 86(9):1006–1008

    CAS  PubMed  Google Scholar 

  65. Laskey MA, Prentice A, Hanratty LA, Jarjou LM, Dibba B, Beavan SR, Cole TJ (1998) Bone changes after 3 mo of lactation: influence of calcium intake, breast-milk output, and vitamin n-receptor genotype. Am J Clin Nutr 67(4):685–692

    CAS  PubMed  Google Scholar 

  66. Sowers M, Randolph J, Shapiro B, Jannausch M (1995) A prospective study of bone density and pregnancy after an extended period of lactation with bone loss. Obstet Gynecol 85(2):285–289. doi:10.1016/0029-7844(94)00351-D

    CAS  PubMed  Google Scholar 

  67. Henderson PH 3rd, Sowers M, Kutzko KE, Jannausch ML (2000) Bone mineral density in grand multiparous women with extended lactation. Am J Obstet Gynecol 182(6):1371–1377. doi:10.1067/mob.2000.107468

    PubMed  Google Scholar 

  68. Sowers M, Corton G, Shapiro B, Jannausch ML, Crutchfield M, Smith ML, Randolph JF, Hollis B (1993) Changes in bone density with lactation. JAMA 269(24):3130–3135

    CAS  PubMed  Google Scholar 

  69. Miller SC, Bowman BM (2007) Rapid inactivation and apoptosis of osteoclasts in the maternal skeleton during the bone remodeling reversal at the end of lactation. Anat Rec (Hoboken) 290(1):65–73. doi:10.1002/ar.20403

    CAS  Google Scholar 

  70. Ardeshirpour L, Dann P, Adams DJ, Nelson T, VanHouten J, Horowitz MC, Wysolmerski JJ (2007) Weaning triggers a decrease in receptor activator of nuclear factor-kappaB ligand expression, widespread osteoclast apoptosis, and rapid recovery of bone mass after lactation in mice. Endocrinology 148(8):3875–3886. doi:10.1210/en.2006-1467

    CAS  PubMed  Google Scholar 

  71. Collins JN, Kirby BJ, Woodrow JP, Gagel RF, Rosen CJ, Sims NA, Kovacs CS (2013) Lactating Ctcgrp nulls lose twice the normal bone mineral content due to fewer osteoblasts and more osteoclasts, whereas bone mass is fully restored after weaning in association with up-regulation of Wnt signaling and other novel genes. Endocrinology 154(4):1400–1413. doi:10.1210/en.2012-1931

    CAS  PubMed Central  PubMed  Google Scholar 

  72. Qing H, Bonewald LF (2009) Osteocyte remodeling of the perilacunar and pericanalicular matrix. Int J Oral Sci 1(2):59–65. doi:10.4248/ijos.09019

    PubMed Central  PubMed  Google Scholar 

  73. Liu XS, Ardeshirpour L, VanHouten JN, Shane E, Wysolmerski JJ (2012) Site-specific changes in bone microarchitecture, mineralization, and stiffness during lactation and after weaning in mice. J Bone Miner Res 27(4):865–875. doi:10.1002/jbmr.1503

    CAS  PubMed  Google Scholar 

  74. Bowman BM, Miller SC (2001) Skeletal adaptations during mammalian reproduction. J Musculoskelet Neuronal Inter 1(4):347–355

    CAS  Google Scholar 

  75. Vajda EG, Bowman BM, Miller SC (2001) Cancellous and cortical bone mechanical properties and tissue dynamics during pregnancy, lactation, and postlactation in the rat. Biol Reprod 65(3):689–695

    CAS  PubMed  Google Scholar 

  76. Bjørnerem A, Ghasem-Zadeh A, Vu T, Seeman E (2010) Bone microstructure during and after lactation [abstract]. J Bone Miner Res 25(Suppl 1):S121

    Google Scholar 

  77. Specker B, Binkley T (2005) High parity is associated with increased bone size and strength. Osteoporos Int 16(12):1969–1974. doi:10.1007/s00198-005-1978-1

    PubMed  Google Scholar 

  78. Wiklund PK, Xu L, Wang Q, Mikkola T, Lyytikainen A, Volgyi E, Munukka E, Cheng SM, Alen M, Keinanen-Kiukaanniemi S, Cheng S (2012) Lactation is associated with greater maternal bone size and bone strength later in life. Osteoporos Int 23(7):1939–1945. doi:10.1007/s00198-011-1790-z

    CAS  PubMed  Google Scholar 

  79. Cross NA, Hillman LS, Allen SH, Krause GF, Vieira NE (1995) Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. Am J Clin Nutr 61(3):514–523

    CAS  PubMed  Google Scholar 

  80. Specker BL, Tsang RC, Ho ML (1991) Changes in calcium homeostasis over the first year postpartum: effect of lactation and weaning. Obstet Gynecol 78(1):56–62

    CAS  PubMed  Google Scholar 

  81. Moller UK, Streym S, Mosekilde L, Heickendorff L, Flyvbjerg A, Frystyk J, Jensen LT, Rejnmark L (2013) Changes in calcitropic hormones, bone markers and insulin-like growth factor I (IGF-I) during pregnancy and postpartum: a controlled cohort study. Osteoporos Int 24(4):1307–1320. doi:10.1007/s00198-012-2062-2

    CAS  PubMed  Google Scholar 

  82. Kalkwarf HJ, Specker BL, Heubi JE, Vieira NE, Yergey AL (1996) Intestinal calcium absorption of women during lactation and after weaning. Am J Clin Nutr 63(4):526–531

    CAS  PubMed  Google Scholar 

  83. Kreiger N, Kelsey JL, Holford TR, O’Connor T (1982) An epidemiologic study of hip fracture in postmenopausal women. Am J Epidemiol 116(1):141–148

    CAS  PubMed  Google Scholar 

  84. Aloia JF, Vaswani AN, Yeh JK, Ross P, Ellis K, Cohn SH (1983) Determinants of bone mass in postmenopausal women. Arch Intern Med 143(9):1700–1704

    CAS  PubMed  Google Scholar 

  85. Aloia JF, Cohn SH, Vaswani A, Yeh JK, Yuen K, Ellis K (1985) Risk factors for postmenopausal osteoporosis. Am J Med 78(1):95–100

    CAS  PubMed  Google Scholar 

  86. Hreshchyshyn MM, Hopkins A, Zylstra S, Anbar M (1988) Associations of parity, breast-feeding, and birth control pills with lumbar spine and femoral neck bone densities. Am J Obstet Gynecol 159(2):318–322

    CAS  PubMed  Google Scholar 

  87. Dequeker J, Tobing L, Rutten V, Geusens P (1991) Relative risk factors for osteoporotic fracture: a pilot study of the MEDOS questionnaire. Clin Rheumatol 10(1):49–53

    CAS  PubMed  Google Scholar 

  88. Feldblum PJ, Zhang J, Rich LE, Fortney JA, Talmage RV (1992) Lactation history and bone mineral density among perimenopausal women. Epidemiology 3(6):527–531

    CAS  PubMed  Google Scholar 

  89. Cumming RG, Klineberg RJ (1993) Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. Int J Epidemiol 22(4):684–691

    CAS  PubMed  Google Scholar 

  90. Berning B, van Kuijk C, Schutte HE, Kuiper JW, Drogendijk AC, Fauser BC (1993) Determinants of lumbar bone mineral density in normal weight, non-smoking women soon after menopause. A study using clinical data and quantitative computed tomography. Bone Miner 21(2):129–139

    CAS  PubMed  Google Scholar 

  91. Cure CC, Ramirez PC, Lopez-Jaramillo P (1998) Osteoporosis, pregnancy, and lactation. Lancet 352(9135):1227–1228

    CAS  PubMed  Google Scholar 

  92. Cure-Cure C, Cure-Ramirez P, Teran E, Lopez-Jaramillo P (2002) Bone-mass peak in multiparity and reduced risk of bone-fractures in menopause. Int J Gynaecol Obstet 76(3):285–291

    CAS  PubMed  Google Scholar 

  93. Bjornerem A, Ahmed LA, Jorgensen L, Stormer J, Joakimsen RM (2011) Breastfeeding protects against hip fracture in postmenopausal women: the Tromso study. J Bone Miner Res 26(12):2843–2850. doi:10.1002/jbmr.496

    PubMed  Google Scholar 

  94. Chapman DJ (2012) Longer cumulative breastfeeding duration associated with improved bone strength. J Hum Lact 28(1):18–19. doi:10.1177/0890334411433573

  95. Canal-Macias ML, Roncero-Martin R, Moran JM, Lavado-Garcia JM, Costa-Fernandez Mdel C, Pedrera-Zamorano JD (2013) Increased bone mineral density is associated with breastfeeding history in premenopausal Spanish women. Arch Med Sci : AMS 9(4):703–708. doi:10.5114/aoms.2013.36903

    CAS  PubMed Central  PubMed  Google Scholar 

  96. Heidari B, Heidari P, Nourooddini HG, Hajian-Tilaki KO (2013) Relationship between parity and bone mass in postmenopausal women according to number of parities and age. J Reprod Med 58(9–10):389–394

    PubMed  Google Scholar 

  97. Schnatz PF, Marakovits KA, O’Sullivan DM (2010) Assessment of postmenopausal women and significant risk factors for osteoporosis. Obstet Gynecol Surv 65(9):591–596. doi:10.1097/OGX.0b013e3181fc6d30

    PubMed  Google Scholar 

  98. Schnatz PF, Barker KG, Marakovits KA, O’Sullivan DM (2010) Effects of age at first pregnancy and breast-feeding on the development of postmenopausal osteoporosis. Menopause 17(6):1161–1166. doi:10.1097/gme.0b013e3181e0efb3

  99. Paton LM, Alexander JL, Nowson CA, Margerison C, Frame MG, Kaymakci B, Wark JD (2003) Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: a twin study. Am J Clin Nutr 77(3):707–714

    CAS  PubMed  Google Scholar 

  100. Parra-Cabrera S, Hernandez-Avila M, Tamayo-y-Orozco J, López-Carrillo L, Meneses-González F (1996) Exercise and reproductive factors as predictors of bone density among osteoporotic women in Mexico City. Calcif Tissue Int 59:89–94

    CAS  PubMed  Google Scholar 

  101. Lissner L, Bengtsson C, Hansson T (1991) Bone mineral content in relation to lactation history in pre- and postmenopausal women. Calcif Tissue Int 48:319–325

    CAS  PubMed  Google Scholar 

  102. Bolzetta F, Veronese N, De Rui M, Berton L, Carraro S, Pizzato S, Girotti G, De Ronch I, Manzato E, Coin A, Sergi G (2014) Duration of breastfeeding as a risk factor for vertebral fractures. Bone 68:41–45. doi:10.1016/j.bone.2014.08.001

    CAS  PubMed  Google Scholar 

  103. Chantry CJ, Auinger P, Byrd RS (2004) Lactation among adolescent mothers and subsequent bone mineral density. Arch Pediatr Adolesc Med 158(7):650–656. doi:10.1001/archpedi.158.7.650

    PubMed  Google Scholar 

  104. Albright F, Reifenstein EC (1948) Parathyroid glands and metabolic bone disease. Williams & Wilkins, Baltimore

    Google Scholar 

  105. Stride PJ, Patel N, Kingston D (2013) The history of osteoporosis: why do Egyptian mummies have porotic bones? J Royal College Phys Edinburgh 43(3):254–261. doi:10.4997/jrcpe.2013.314

    CAS  Google Scholar 

  106. Yamamoto N, Takahashi HE, Tanizawa T, Kawashima T, Endo N (1994) Bone mineral density and bone histomorphometric assessments of postpregnancy osteoporosis: a report of five patients. Calcif Tissue Int 54(1):20–25

    CAS  PubMed  Google Scholar 

  107. Smith R, Athanasou NA, Ostlere SJ, Vipond SE (1995) Pregnancy-associated osteoporosis. Q J Med 88(12):865–878

    CAS  Google Scholar 

  108. Khovidhunkit W, Epstein S (1996) Osteoporosis in pregnancy. Osteoporos Int 6(5):345–354

    CAS  PubMed  Google Scholar 

  109. Phillips AJ, Ostlere SJ, Smith R (2000) Pregnancy-associated osteoporosis: does the skeleton recover? Osteoporos Int 11(5):449–454. doi:10.1007/s001980070113

    CAS  PubMed  Google Scholar 

  110. Smith R, Stevenson JC, Winearls CG, Woods CG, Wordsworth BP (1985) Osteoporosis of pregnancy. Lancet 1(8439):1178–1180

    CAS  PubMed  Google Scholar 

  111. Campos-Obando N, Oei L, Hoefsloot LH, Kiewiet RM, Klaver CC, Simon ME, Zillikens MC (2014) Osteoporotic vertebral fractures during pregnancy: be aware of a potential underlying genetic cause. J Clin Endocrinol Metab 99(4):1107–1111. doi:10.1210/jc.2013-3238

    CAS  PubMed  Google Scholar 

  112. Cook FJ, Mumm S, Whyte MP, Wenkert D (2014) Pregnancy-associated osteoporosis with a heterozygous deactivating LDL receptor-related protein 5 (LRP5) mutation and a homozygous methylenetetrahydrofolate reductase (MTHFR) polymorphism. J Bone Miner Res 29(4):922–928. doi:10.1002/jbmr.2095

    CAS  PubMed  Google Scholar 

  113. O’Sullivan SM, Grey AB, Singh R, Reid IR (2006) Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int 17(7):1008–1012. doi:10.1007/s00198-006-0112-3

    PubMed  Google Scholar 

  114. Khastgir G, Studd JW, King H, Abdalla H, Jones J, Carter G, Alaghband-Zadeh J (1996) Changes in bone density and biochemical markers of bone turnover in pregnancy-associated osteoporosis. Br J Obstet Gynaecol 103(7):716–718

    CAS  PubMed  Google Scholar 

  115. Bonacker J, Janousek M, Krober M (2014) Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report. Arch Orthop Trauma Surg 134(2):173–179. doi:10.1007/s00402-013-1912-5

    CAS  PubMed  Google Scholar 

  116. Lampropoulou-Adamidou K, Trovas G, Stathopoulos IP, Papaioannou NA (2012) Case report: Teriparatide treatment in a case of severe pregnancy -and lactation- associated osteoporosis. Hormones (Athens, Greece) 11(4):495–500

    Google Scholar 

  117. Stumpf UC, Kurth AA, Windolf J, Fassbender WJ (2007) Pregnancy-associated osteoporosis: an underestimated and underdiagnosed severe disease. A review of two cases in short- and long-term follow-up. Adv Med Sci 52:94–97

    CAS  PubMed  Google Scholar 

  118. Dunne F, Walters B, Marshall T, Heath DA (1993) Pregnancy associated osteoporosis. Clin Endocrinol (Oxf) 39(4):487–490

    CAS  Google Scholar 

  119. Lopez LM, Chen M, Mullins S, Curtis KM, Helmerhorst FM (2012) Steroidal contraceptives and bone fractures in women: evidence from observational studies. Cochrane Database Syst Rev 8:CD009849. doi:10.1002/14651858.CD009849.pub2

    PubMed  Google Scholar 

  120. Lopez LM, Grimes DA, Schulz KF, Curtis KM, Chen M (2014) Steroidal contraceptives: effect on bone fractures in women. Cochrane Database Syst Rev 6:CD006033. doi:10.1002/14651858.CD006033.pub5

    PubMed  Google Scholar 

  121. Brandao KL, Mottola MF, Gratton R, Maloni J (2013) Bone status in activity-restricted pregnant women assessed using calcaneal quantitative ultrasound. Biol Res Nurs 15(2):205–212. doi:10.1177/1099800411423807

    CAS  PubMed  Google Scholar 

  122. Dent CE, Friedman M (1965) Pregnancy and idiopathic osteoporosis. Q J Med 34(135):341–357

    CAS  PubMed  Google Scholar 

  123. Nordin BE, Roper A (1955) Post-pregnancy osteoporosis; a syndrome? Lancet 268(6861):431–434

    CAS  PubMed  Google Scholar 

  124. Longstreth PL, Malinak LR, Hill CS Jr (1973) Transient osteoporosis of the hip in pregnancy. Obstet Gynecol 41(4):563–569

    CAS  PubMed  Google Scholar 

  125. Brodell JD, Burns JE Jr, Heiple KG (1989) Transient osteoporosis of the hip of pregnancy. Two cases complicated by pathological fracture. J Bone Joint Surg Am 71(8):1252–1257

    CAS  PubMed  Google Scholar 

  126. Goldman GA, Friedman S, Hod M, Ovadia J (1994) Idiopathic transient osteoporosis of the hip in pregnancy. Int J Gynaecol Obstet 46(3):317–320

    CAS  PubMed  Google Scholar 

  127. Guerra JJ, Steinberg ME (1995) Distinguishing transient osteoporosis from avascular necrosis of the hip. J Bone Joint Surg Am 77(4):616–624

    CAS  PubMed  Google Scholar 

  128. Cano-Marquina A, Tarin JJ, Garcia-Perez MA, Cano A (2014) Transient regional osteoporosis. Maturitas 77(4):324–329. doi:10.1016/j.maturitas.2014.01.012

    PubMed  Google Scholar 

  129. Lose G, Lindholm P (1986) Transient painful osteoporosis of the hip in pregnancy. Int J Gynaecol Obstet 24(1):13–16

    CAS  PubMed  Google Scholar 

  130. Funk JL, Shoback DM, Genant HK (1995) Transient osteoporosis of the hip in pregnancy: natural history of changes in bone mineral density. Clin Endocrinol (Oxf) 43(3):373–382

    CAS  Google Scholar 

  131. Emami MJ, Abdollahpour HR, Kazemi AR, Vosoughi AR (2012) Bilateral subcapital femoral neck fractures secondary to transient osteoporosis during pregnancy: a case report. J Orthop Surg (Hong Kong) 20(2):260–262

    Google Scholar 

  132. Pabinger C, Heu C, Frohner A, Dimai HP (2012) Pregnancy- and lactation-associated transient osteoporosis of both hips in a 32 year old patient with osteogenesis imperfecta. Bone 51(1):142–144. doi:10.1016/j.bone.2012.04.013

    CAS  PubMed  Google Scholar 

  133. Curtiss PH Jr, Kincaid WE (1959) Transitory demineralization of the hip in pregnancy. A report of three cases. J Bone Joint Surg Am 41-A:1327–1333

    PubMed  Google Scholar 

  134. Anai T, Urata K, Mori A, Miyazaki F, Okamoto S (2013) Transient osteoporosis of the hip in pregnancy associated with generalized low bone mineral density—a case report. Gynecol Obstet Invest 76(2):133–138. doi:10.1159/000351564

    PubMed  Google Scholar 

  135. Lakhanpal S, Ginsburg WW, Luthra HS, Hunder GG (1987) Transient regional osteoporosis. A study of 56 cases and review of the literature. Ann Intern Med 106(3):444–450

    CAS  PubMed  Google Scholar 

  136. Takatori Y, Kokubo T, Ninomiya S, Nakamura T, Okutsu I, Kamogawa M (1991) Transient osteoporosis of the hip. Magnetic resonance imaging. Clin Orthop Relat Res 271(271):190–194

    PubMed  Google Scholar 

  137. Aynaci O, Kerimoglu S, Ozturk C, Saracoglu M (2008) Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis. Arch Orthop Trauma Surg 128(3):313–316. doi:10.1007/s00402-007-0439-z

    PubMed  Google Scholar 

  138. Bruscas Izu C, Juan S, de la Parra S (2014) Transient osteoporosis of both hips in pregnancy. Reumatol Clin 10(1):58–59. doi:10.1016/j.reuma.2013.01.009

    PubMed  Google Scholar 

  139. Baki ME, Uygun H, Ari B, Aydin H (2014) Bilateral femoral neck insufficiency fractures in pregnancy. Eklem hastaliklari ve cerrahisi = Joint Dis Relat Surg 25(1):60–62. doi:10.5606/ehc.2014.13

    Google Scholar 

  140. Pallavi P, Padma S, Vanitha Anna Selvi D (2012) Transient osteoporosis of hip and lumbar spine in pregnancy. J Obstet Gynaecol India 62(Suppl 1):8–9. doi:10.1007/s13224-013-0355-9

    CAS  PubMed Central  PubMed  Google Scholar 

  141. Ofluoglu O, Ofluoglu D (2008) A case report: pregnancy-induced severe osteoporosis with eight vertebral fractures. Rheumatol Int 29(2):197–201. doi:10.1007/s00296-008-0641-5

    PubMed  Google Scholar 

  142. Ozturk C, Atamaz FC, Akkurt H, Akkoc Y (2014) Pregnancy-associated osteoporosis presenting severe vertebral fractures. J Obstet Gynaecol Res 40(1):288–292. doi:10.1111/jog.12157

    CAS  PubMed  Google Scholar 

  143. Reid IR, Wattie DJ, Evans MC, Budayr AA (1992) Post-pregnancy osteoporosis associated with hypercalcaemia. Clin Endocrinol (Oxf) 37(3):298–303

    CAS  Google Scholar 

  144. Iwamoto J, Sato Y, Uzawa M, Matsumoto H (2012) Five-year follow-up of a woman with pregnancy and lactation-associated osteoporosis and vertebral fractures. Ther Clin Risk Manag 8:195–199. doi:10.2147/tcrm.s30668

    CAS  PubMed Central  PubMed  Google Scholar 

  145. Dytfeld J, Horst-Sikorska W (2012) Pregnancy associated osteoporosis—a case report. Ginekol Pol 83(5):377–379

    PubMed  Google Scholar 

  146. Sarikaya S, Ozdolap S, Acikgoz G, Erdem CZ (2004) Pregnancy-associated osteoporosis with vertebral fractures and scoliosis. Joint Bone Spine 71(1):84–85. doi:10.1016/j.jbspin.2003.05.003

    PubMed  Google Scholar 

  147. Choe EY, Song JE, Park KH, Seok H, Lee EJ, Lim SK, Rhee Y (2012) Effect of teriparatide on pregnancy and lactation-associated osteoporosis with multiple vertebral fractures. J Bone Miner Metab 30(5):596–601. doi:10.1007/s00774-011-0334-0

    CAS  PubMed  Google Scholar 

  148. Jang JY, Lee JG, Jeong IK, Ahn KJ, Chung HY, Yang HI, Lee SH (2009) A case of post-pregnancy osteoporosis combined with ankylosing spondylitis. Rheumatol Int 29(11):1359–1362. doi:10.1007/s00296-008-0820-4

    PubMed  Google Scholar 

  149. Ozcelik B, Ozcelik A, Debre M (2009) Postpartum depression co-occurring with lactation-related osteoporosis. Psychosomatics 50(2):155–158. doi:10.1176/appi.psy.50.2.155

    CAS  PubMed  Google Scholar 

  150. Tanriover MD, Oz SG, Sozen T, Kilicarslan A, Guven GS (2009) Pregnancy- and lactation-associated osteoporosis with severe vertebral deformities: can strontium ranelate be a new alternative for the treatment? Spine J 9(4):e20–e24. doi:10.1016/j.spinee.2008.06.451

    PubMed  Google Scholar 

  151. Zarattini G, Buffoli P, Isabelli G, Marchese M (2014) Pregnancy-associated osteoporosis with seven vertebral compression fractures, a case treated with strontium ranelate. Clin Cases Min Bone Metab 11(2):139–141

  152. Hellmeyer L, Boekhoff J, Hadji P (2010) Treatment with teriparatide in a patient with pregnancy-associated osteoporosis. Gynecol Endocrinol 26(10):725–728. doi:10.3109/09513591003649831

    CAS  PubMed  Google Scholar 

  153. Lee SH, Hong MK, Park SW, Park HM, Kim J, Ahn J (2013) A case of teriparatide on pregnancy-induced osteoporosis. J Bone Metab 20 (2):111–114. doi:10.11005/jbm.2013.20.2.111

  154. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, Gagel RF, Gilsanz V, Guise T, Koka S, McCauley LK, McGowan J, McKee MD, Mohla S, Pendrys DG, Raisz LG, Ruggiero SL, Shafer DM, Shum L, Silverman SL, Van Poznak CH, Watts N, Woo SB, Shane E, American Society for B, Mineral R (2007) Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 22(10):1479–1491. doi:10.1359/jbmr.0707onj

    PubMed  Google Scholar 

  155. Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster DW, Ebeling PR, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O’Keefe R, Papapoulos S, Howe TS, van der Meulen MC, Weinstein RS, Whyte MP (2014) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 29(1):1–23. doi:10.1002/jbmr.1998

    PubMed  Google Scholar 

  156. Uyanne J, Calhoun CC, Le AD (2014) Antiresorptive drug-related osteonecrosis of the jaw. Dent Clin N Am 58(2):369–384. doi:10.1016/j.cden.2013.12.006

    PubMed  Google Scholar 

  157. Thompson RN, Armstrong CL, Heyburn G (2014) Bilateral atypical femoral fractures in a patient prescribed denosumab—a case report. Bone 61:44–47. doi:10.1016/j.bone.2013.12.027

    PubMed  Google Scholar 

  158. Abrahamsen B, Grove EL, Vestergaard P (2014) Nationwide registry-based analysis of cardiovascular risk factors and adverse outcomes in patients treated with strontium ranelate. Osteoporos Int 25(2):757–762. doi:10.1007/s00198-013-2469-4

    CAS  PubMed  Google Scholar 

  159. Donneau AF, Reginster JY (2014) Cardiovascular safety of strontium ranelate: real-life assessment in clinical practice. Osteoporos Int 25(2):397–398. doi:10.1007/s00198-013-2583-3

    PubMed Central  PubMed  Google Scholar 

  160. Patlas N, Golomb G, Yaffe P, Pinto T, Breuer E, Ornoy A (1999) Transplacental effects of bisphosphonates on fetal skeletal ossification and mineralization in rats. Teratology 60(2):68–73. doi:10.1002/(SICI)1096-9926(199908)60:2<68::AID-TERA10>3.0.CO;2-H

    CAS  PubMed  Google Scholar 

  161. Okazaki A, Matsuzawa T, Takeda M, York RG, Barrow PC, King VC, Bailey GP (1995) Intravenous reproductive and developmental toxicity studies of cimadronate (YM175), a novel bisphosphonate, in rats and rabbits. J Toxicol Sci 20(Suppl 1):1–13

    CAS  PubMed  Google Scholar 

  162. Stathopoulos IP, Liakou CG, Katsalira A, Trovas G, Lyritis GG, Papaioannou NA, Tournis S (2011) The use of bisphosphonates in women prior to or during pregnancy and lactation. Hormones (Athens, Greece) 10(4):280–291

    Google Scholar 

  163. Siminoski K, Fitzgerald AA, Flesch G, Gross MS (2000) Intravenous pamidronate for treatment of reflex sympathetic dystrophy during breast feeding. J Bone Miner Res 15(10):2052–2055. doi:10.1359/jbmr.2000.15.10.2052

    CAS  PubMed  Google Scholar 

  164. Boyce RW, Varela A, Chouinard L, Bussiere JL, Chellman GJ, Ominsky MS, Pyrah IT (2014) Infant cynomolgus monkeys exposed to denosumab in utero exhibit an osteoclast-poor osteopetrotic-like skeletal phenotype at birth and in the early postnatal period. Bone 64:314–325. doi:10.1016/j.bone.2014.04.002

    CAS  PubMed  Google Scholar 

  165. Servier Laboratories (2014) Protos Datasheet. New Zealand Medicines and Medical Devices Safety Authority. http://www.medsafe.govt.nz/profs/datasheet/p/Protossusp.pdf. Accessed March 5, 2015

  166. Kim HW, Song JW, Kwon A, Kim IH (2010) Percutaneous vertebroplasty for pregnancy-associated osteoporotic vertebral compression fractures. J Korean Neurosurg Soc 47(5):399–402. doi:10.3340/jkns.2010.47.5.399

    PubMed Central  PubMed  Google Scholar 

  167. Bayram S, Ozturk C, Sivrioglu K, Aydinli U, Kucukoglu S (2006) Kyphoplasty for pregnancy-associated osteoporotic vertebral fractures. Joint Bone Spine 73(5):564–566. doi:10.1016/j.jbspin.2005.11.015

    PubMed  Google Scholar 

  168. Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361(6):557–568. doi:10.1056/NEJMoa0900429

    CAS  PubMed  Google Scholar 

  169. Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361(6):569–579. doi:10.1056/NEJMoa0900563

    CAS  PubMed Central  PubMed  Google Scholar 

  170. Baroud G, Bohner M (2006) Biomechanical impact of vertebroplasty. Postoperative biomechanics of vertebroplasty. Joint Bone Spine 73(2):144–150. doi:10.1016/j.jbspin.2005.02.004

    PubMed  Google Scholar 

  171. Baroud G, Nemes J, Heini P, Steffen T (2003) Load shift of the intervertebral disc after a vertebroplasty: a finite-element study. Eur Spine J 12(4):421–426. doi:10.1007/s00586-002-0512-9

    CAS  PubMed Central  PubMed  Google Scholar 

  172. Han IH, Chin DK, Kuh SU, Kim KS, Jin BH, Yoon YS, Cho YE (2009) Magnetic resonance imaging findings of subsequent fractures after vertebroplasty. Neurosurgery 64(4):740–744. doi:10.1227/01.neu.0000339120.41053.f1

  173. Truszczynska A, Walczak P, Rapala K (2012) Transient peripartum osteoporosis of the femoral head in first and third pregnancy. J Clin Densitom 15(4):467–471. doi:10.1016/j.jocd.2012.02.010

    PubMed  Google Scholar 

Download references

Acknowledgments

The study received research grant support to CSK from Canadian Institutes of Health Research (grant no. 133413 and no. 84253).

Conflicts of interest

SHR reports having received consultancy fees on behalf of his institution from Novartis and Merck and research grants to his institution from Amgen and Eli Lilly. CSK has received honoraria from Amgen for work unrelated to the topic of this review.

Author information

Authors and Affiliations

  1. Faculty of Medicine—Endocrinology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada, A1B 3V6

    C. S. Kovacs

  2. Rheumatology and Bone Disease Research Group, Institute of Genetics and Molecular Medicine, Edinburgh University, Western General Hospital, Edinburgh, EH2 4XU, UK

    S. H. Ralston

  3. Health Sciences Centre, 300 Prince Philip Drive, St. John’s, NL, A1B 3V6, Canada

    C. S. Kovacs

Authors
  1. C. S. Kovacs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. H. Ralston
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. S. Kovacs.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kovacs, C.S., Ralston, S.H. Presentation and management of osteoporosis presenting in association with pregnancy or lactation. Osteoporos Int 26, 2223–2241 (2015). https://doi.org/10.1007/s00198-015-3149-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-015-3149-3

Keywords

search

Navigation