Pregnancy and Lactation Associated Bone Fragility.

Area of Science:

• Reproductive endocrinology
• Bone metabolism
• Mineral homeostasis

Background:

• The maternal skeleton is a crucial calcium reservoir, particularly during lactation.
• Skeletal resorption is hormonally regulated, increasing significantly during lactation.
• While typically transient, bone loss can rarely lead to fragility fractures.

Purpose of the Study:

• To review the epidemiology, pathophysiology, diagnostics, and treatment of skeletal complications during reproduction.
• To evaluate the necessity and efficacy of pharmacotherapy for bone loss in premenopausal women.

Main Methods:

• Mini-review of existing literature on skeletal changes during pregnancy and lactation.
• Discussion of diagnostic criteria and therapeutic approaches.
• Analysis of the role of pharmacotherapy and the need for clinical trials.

Main Results:

• Lactation causes 5-10% spinal bone density loss, independent of calcium intake.
• Fragility fractures, including vertebral compression fractures, can occur, especially if pre-pregnancy bone health was compromised.
• The skeleton generally recovers post-weaning, even after fractures, casting doubt on routine pharmacotherapy.

Conclusions:

• Skeletal changes during reproduction are usually reversible, but fractures can occur.
• The necessity and optimal agents for pharmacotherapy in premenopausal women with reproductive-related bone loss remain uncertain.
• Further randomized trials are required to guide treatment decisions.