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Bone metabolism and osteoporosis during pregnancy and lactation

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Abstract

Purpose

Osteoporosis in pregnancy is an uncommon disease and there is little information regarding its pathogenesis and its effects on the skeleton. This review aims to describe changes in mineral metabolism during pregnancy and lactation as well as their clinical impact.

Methods

We performed a narrative review of the literature using the PubMed and Google Scholar databases for articles published from 1955 to 2021.

Results

Mineral metabolism in the mother must adapt to the demand created by the fetus and the placenta, which together absorb calcium and other minerals from the mother to mineralize the developing fetal skeleton; analyses of iliac bone biopsies at the beginning and end of pregnancy have shown that pregnancy significantly modifies maternal bone status. The greatest demand for calcium for the maternal skeleton occurs during lactation; women who breastfeed have an even greater loss of calcium to produce milk. However, it is controversial whether breastfeeding can increase the risk of osteoporotic fractures, and the possible mechanism is considerably complicated. Osteoporosis in pregnancy is an uncommon disease characterized by the occurrence of fragility fractures, most commonly in the vertebral column, in the third trimester of pregnancy, or early postpartum. The pathogenesis of PLO remains unclear owing to its rarity; DXA provides a sensitive and specific method for diagnosing osteoporosis by measuring BMD, one of the parameters that allow a better understanding of fracture risk. One limitation is the controversy in using radiation in pregnant women and the risk to the embryo/fetus; a safe alternative can be MRI.

Conclusion

Pregnancy and lactation alter the maternal bone status; without a balance in metabolism, this may cause an increased risk of fracture due to changes in BMD. There is little information on BMD during pregnancy; more clinical studies are required to elucidate if this represents a risk factor for osteoporosis.

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Acknowledgements

We thank Dr. Sergio Lozano-Rodriguez for his help in reviewing and editing the manuscript.

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Authors and Affiliations

  1. Rheumatology Service, Hospital Universitario “Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 Norte, C. P. 64460, Monterrey, Nuevo León, Colonia Mitras Centro, Mexico

    Abraham Yair Lujano-Negrete, Martha Cecilia Rodríguez-Ruiz, Cassandra Michele Skinner-Taylor, Lorena Perez-Barbosa, Jesus Alberto Cardenas de la Garza, Pedro Alberto García-Hernández, Luis Gerardo Espinosa-Banuelos, Luz Fernanda Gutierrez-Leal, Sofia Jezzini-Martínez & Dionicio Ángel Galarza-Delgado

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  1. Abraham Yair Lujano-Negrete
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Correspondence to Cassandra Michele Skinner-Taylor.

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Lujano-Negrete, A.Y., Rodríguez-Ruiz, M.C., Skinner-Taylor, C.M. et al. Bone metabolism and osteoporosis during pregnancy and lactation. Arch Osteoporos 17, 36 (2022). https://doi.org/10.1007/s11657-022-01077-x

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