Skip to main content

Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up

Osteoporosis International volume 29, pages 135–142 (2018)Cite this article

Abstract

Summary

Almost a quarter of patients with PAO will sustain a subsequent fracture; patients need to be informed about potential risks before deciding for further pregnancies.

Introduction

Pregnancy and lactation-associated osteoporosis (PAO) is a severe type of premenopausal osteoporosis which predominantly occurs in the last trimester of pregnancy or immediately postpartum. Long-term follow-up data including subsequent fracture risk have yet to be reported.

Methods

This single-center prospective cohort study investigated the subsequent fracture risk of all 107 patients with PAO who were referred to our institution.

Results

Overall, 107 presented with at least one fracture. Each patient sustained on average four fractures most commonly at the thoracolumbar spine. During a median of 6 years of follow-up, 26 (24.3%) of patients who had a fracture at baseline reported a subsequent fracture. Overall, 30 PAO patients (28%) reported a further pregnancy. In subsequent pregnancies, 6 (20%) of patients reported a subsequent fracture. Patients with up to 1 vs. > 1 fracture at time of diagnosis showed a 3 (10%) and 25 (27%) subsequent fracture rate, respectively (p = 0.047). There was a significant correlation between the number of fractures at time of diagnosis and subsequent fracture risk (N = 26,p= 0.56, p = 0.003).

Conclusions

Almost a quarter of patients with PAO will sustain a subsequent fracture, and this fracture risk correlates with the number of fractures at time of diagnosis. Patients with PAO need to be informed about their potential subsequent fracture risk before deciding for further pregnancies.

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

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

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

    CAS  Article  PubMed  Google Scholar 

  2. Ferrari S, Bianchi ML, Eisman JA, Foldes AJ, Adami S, Wahl DA et al (2012) Osteoporosis in young adults: pathophysiology, diagnosis, and management. Osteoporos Int 23(12):2735–2748

    CAS  Article  PubMed  Google Scholar 

  3. Winarno AS, Kyvernitakis I, Hadji P (2014) Successful treatment of 1-34 parathyroid hormone (PTH) after failure of bisphosphonate therapy in a complex case of pregnancy associated osteoporosis and multiple fractures. Z Geburtshilfe Neonatol 218(4):171–173

    CAS  Article  PubMed  Google Scholar 

  4. Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I (2017) Pregnancy-associated osteoporosis: a case-control study. Osteoporos Int 28(4):1393–1399

    CAS  Article  PubMed  Google Scholar 

  5. Kyvernitakis I, Hadji P (2016) Postmenopausal osteoporosis. Diagnosis and treatment according to the S3 guidelines. Gynakol Endokrinol 14(3):197–207

    CAS  Article  Google Scholar 

  6. Kovacs CS (2014) Osteoporosis presenting in pregnancy, puerperium, and lactation. Curr Opin Endocrinol Diabetes Obes 21(6):468–475

    Article  PubMed  Google Scholar 

  7. Kovacs CS (2016) Maternal .mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery. Physiol Rev 96(2):449–547

    CAS  Article  PubMed  Google Scholar 

  8. Kovacs CS (2012) The role of vitamin D in pregnancy and lactation: insights from animal models and clinical studies. Annu Rev Nutr 32:97–123

    CAS  Article  PubMed  Google Scholar 

  9. Kovacs CS (2001) Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab 86(6):2344–2348

    CAS  PubMed  Google Scholar 

  10. Kovacs CS (2008) Vitamin D in pregnancy and lactation: maternal, fetal, and neonatal outcomes from human and animal studies. Am J Clin Nutr 88(2):520S–528S

    CAS  PubMed  Google Scholar 

  11. Kovacs CS, Ralston SH (2015) Presentation and management of osteoporosis presenting in association with pregnancy or lactation. Osteoporos Int 26(9):2223–2241

    CAS  Article  PubMed  Google Scholar 

  12. Campos-Obando N, Oei L, Hoefsloot LH, Kiewiet RM, Klaver CC, Simon ME et al (2014) Osteoporotic vertebral fractures during pregnancy: be aware of a potential underlying genetic cause. J Clin Endocrinol Metab 99(4):1107–1111

    CAS  Article  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  14. Kovacs CS, Fuleihan GH (2006) Calcium and bone disorders during pregnancy and lactation. Endocrinol Metab Clin N Am 35(1):21–51 v

    CAS  Article  Google Scholar 

  15. Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I (2017) Pregnancy-associated osteoporosis: a case-control study. Osteoporos Int 28(4):1393–1399

  16. Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I (2017) Pregnancy-associated transient osteoporosis of the hip: results of a case-control study. Arch Osteoporos 12(1):11

    Article  PubMed  Google Scholar 

  17. Hellmeyer L, Hahn B, Fischer C, Hars O, Boekhoff J, Maier J et al (2015) Quantitative ultrasonometry during pregnancy and lactation: a longitudinal study. Osteoporos Int 26(3):1147–1154

    CAS  Article  PubMed  Google Scholar 

  18. Lopez JM, Gonzalez G, Reyes V, Campino C, Diaz S (1996) Bone turnover and density in healthy women during breastfeeding and after weaning. Osteoporos Int 6(2):153–159

    CAS  Article  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  20. Nakamura Y, Kamimura M, Ikegami S, Mukaiyama K, Komatsu M, Uchiyama S et al (2015) A case series of pregnancy- and lactation-associated osteoporosis and a review of the literature. Ther Clin Risk Manag 11:1361–1365

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bishop N, Arundel P, Clark E, Dimitri P, Farr J, Jones G et al (2014) Fracture prediction and the definition of osteoporosis in children and adolescents: the ISCD 2013 Pediatric Official Positions. J Clin Densitom 17(2):275–280

    Article  PubMed  Google Scholar 

  22. Nakamura T (2001) Definition and classification of osteoporotic vertebral fracture. Clin Calcium 11(9):1176–1181

    CAS  PubMed  Google Scholar 

  23. Pfeilschifter J (2015) Diagnosing osteoporosis: what is new in the 2014 DVO guideline? Dtsch Med Wochenschr 140(22):1667–1671

    Article  PubMed  Google Scholar 

  24. Hadji P, Imani P, Wuster C, Hars O, Albert US, Kyvernitakis I (2015) Comparison of dual-energy X-ray absorptiometry with six quantitative ultrasonometry devices in women with hip fractures. Climacteric 18(3):411–418

    CAS  Article  PubMed  Google Scholar 

  25. Hadji P, Ziller V, Kalder M, Gottschalk M, Hellmeyer L, Hars O et al (2002) Influence of pregnancy and breast-feeding on quantitative ultrasonometry of bone in postmenopausal women. Climacteric 5(3):277–285

    CAS  Article  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  27. Smith R, Athanasou NA, Ostlere SJ, Vipond SE (1995) Pregnancy-associated osteoporosis. QJM 88(12):865–878

    CAS  PubMed  Google Scholar 

  28. O'Sullivan SM, Grey AB, Singh R, Reid IR (2006) Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int 17(7):1008–1012

    Article  PubMed  Google Scholar 

  29. 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

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank our patients for their contribution to this study.

Author information

Affiliations

  1. Department of Obstetrics and Gynecology, Buergerhospital and Clementine Kinderhospital Frankfurt, Goethe-University of Frankfurt, Nibelungenallee 37-41, 60318, Frankfurt a.M., Germany

    I. Kyvernitakis

  2. Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany

    I. Kyvernitakis, T. C. Reuter, L. Hellmeyer & P. Hadji

  3. Department of Obstetrics and Gynecology, Vivantes Klinikum Berlin, Berlin, Germany

    L. Hellmeyer

  4. Stastistical Institute, Berlin, Germany

    O. Hars

  5. German Reference Centre for Pregnancy-Associated Osteoporosis, Department of Osteoporosis, Endocrinology and Reproductive Medicine, Frankfurt, Germany

    P. Hadji

Authors
  1. I. Kyvernitakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. C. Reuter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Hellmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O. Hars
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Hadji
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Kyvernitakis.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kyvernitakis, I., Reuter, T.C., Hellmeyer, L. et al. Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up. Osteoporos Int 29, 135–142 (2018). https://doi.org/10.1007/s00198-017-4239-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-017-4239-1

Keywords

  • Fracture risk
  • Pregnancy and lactation-associated osteoporosis