title: Osteoporosis presenting in pregnancy, puerperium, and lactation.
abstract: OBJECTIVE
  To describe our current state of knowledge about the pathophysiology, incidence, and treatment of osteoporosis that presents during pregnancy, puerperium, and lactation.
  
  
  RESULTS
  When vertebral fractures occur in pregnant or lactating women, it is usually unknown whether the skeleton was normal before pregnancy. Maternal adaptations increase bone resorption modestly during pregnancy but markedly during lactation. The net bone loss may occasionally precipitate fractures, especially in women who have underlying low bone mass or skeletal fragility prior to pregnancy. Bone mass and strength are normally restored postweaning. Transient osteoporosis of the hip is a sporadic disorder localized to one or both femoral heads; it is not due to generalized skeletal resorption. Anecdotal reports have used bisphosphonates, strontium ranelate, teriparatide, or vertebroplasty/kyphoplasty to treat postpartum vertebral fractures, but it is unclear whether these therapies had any added benefit over the spontaneous skeletal recovery that normally occurs after weaning.
  
  
  CONCLUSIONS
  These relatively rare fragility fractures result from multifactorial causes, including skeletal disorders that precede pregnancy, and structural and metabolic stresses that can compromise skeletal strength during pregnancy and lactation. Further study is needed to determine when pharmacological or surgical therapy is warranted instead of conservative or expectant management.
authors.affiliation: Faculty of Medicine - Endocrinology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kovacs
mesh_terms: D000328:Adult; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001942:Breast Feeding; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D010281:Parathyroid Hormone / Q000378:metabolism; D049590:Postpartum Period; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D016103:Spinal Fractures / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control; D019379:Teriparatide / Q000008:administration & dosage / Q000009:adverse effects; D014886:Weaning
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; C470125:PTH protein, human; D010281:Parathyroid Hormone; D019379:Teriparatide