Osteoporosis in Pregnant Women: What You Should Be Aware Of and How You Can Help

Pregnancy and breast feeding cause massive changes in a woman’s body. One of the changes is the effect on bones. Osteoporosis means ‘porous bones’. It’s a condition in which the quality and density of bones is diminished, resulting in them getting weak and brittle, and more susceptible to fracture. According to the National Osteoporosis Society “it occurs when struts which make up the mesh-like structure within bones become thin causing bones to become fragile and break easily following a minor bump or fall”. Although broken bones can occur in different parts of the body, the hips, wrists and spine are the most commonly affected.

What it is

Experts believe that osteoporosis associated with pregnancy is an odd condition where, in otherwise healthy women, bones break suddenly, usually in the spine or the hip, or acute pain arises during or after pregnancy. Most women’s bone density increase and strengthen throughout their adolescence and into their 20’s, reaches its peak bone mass at the age of 30, and starts gradually decreasing after the age of 35. Women lose out more rapidly because of menopause and the production of lower levels of estrogen, with risks of osteoporosis increasing as you age. Studies suggest that, in pregnant women, bone density decreases in the last trimester because the baby requires calcium from its mother. but restores itself after birth. Similarly, bone density decreases when a mother breast feeds, but is normalised when the baby is weaned. During pregnancy, the baby growing requires plenty of calcium to develop its bones. This requirement is especially immense during the last 3 months of pregnancy. If the mother doesn’t have access to enough calcium, the baby will absorb what it needs from the mother’s bones. Women in their fertile years are not habitual of consuming calcium. Osteoporotic fractures are also commonly found to be associated with first pregnancies, barring rare cases where some women face it after a first normal pregnancy.

Why it happens

It is uncertain why women develop fragile bones during pregnancy. It is possible that some women have low bone density before they become pregnant and the increase in bone metabolism due to pregnancy adds more stress to the skeleton. If a mother has osteoporosis, the doctor can advise against breast-feeding because it can delay the recovery of your bone strength. One early sign can be a loss of height due to compression of the spine or curvature. If your doctor finds you are shorter than you think you are or if you notice a “dowager’s hump”, consulting your doctor is essential.

Causes

—> Bone mass starts decreasing after 35 years of age, and bone loss occurs more frequently in women after menopause.

—> Patients with osteoporosis have no identifiable symptoms until an actual bone fracture takes place.

—> A pregnant woman with thin build and minimal physical activity is more prone to osteoporosis.

—> Low levels of dietary calcium intake and Vitamin D in your diet.

—> Excessive alcohol or caffeine consumption and smoking can also contribute to brittle bones.

—> Deficiency of estrogen because of irregular periods, surgical removal of the ovaries, menopause before the age of 40, or post-menopause.

—> Osteoporosis related with pregnancy can take the form of;
Transient osteoporosis, primarily affecting the femoral neck of the hip and the lumbar spine. It is marked by the onset of a sharp pain following fracture or chronic backache.
Migratory osteoporosis can shift to other areas of the body and manifests in constant joints pain.

—> Many pregnant woman experience back pain due to changes in the ligaments and alteration of stresses on the pelvis and spine, but if the pain persists, lasts hours and surprises you, it is advisable to consult a health care professional.

Treatment:

—> What you need to remember is that fractures will heal and bone density can be improved. Treatment options also depend upon the age, medical history and the severity of osteoporosis.

—> Osteoporosis can go undetected because doctors do not want to expose the unborn baby to radiation, and are reluctant to take X-Rays, in which case, the X-Rays are delayed until after the baby is born.

—> Bone Density Scanning (DXA) reveals information about bone strength. If the result is below the normal bone density level, it will confirm osteoporosis. This scan emits a lower amount of radiation, but is only recommended in severe cases so as to not harm the baby.

—> Regular weight bearing exercises, or simply walking for at least 30 minutes, should be maintained because it stimulates new bone formation.

—> A diet that is rich in calcium (1000mg per day) and Vitamin D is necessary to slow the rate of bone loss. Foods high in calcium and Vitamin D are; dark green vegetables, dairy products, eggs, fish (tuna, sardines), cereals, nuts and soybean. Moderately regular exposure to sunlight also helps to produce Vitamin D in the body.

—> A drug treatment is only viable if it does not affect the baby, and as a short-term option. Calcitonin is an osteoporosis drug given either by injection or nasal spray to help with the spinal fracture pain.

—> Hormone Replacement Therapy is also suggested for pregnant women with osteoporosis. Oestrogen elevates the calcium balance and helps in reducing bone loss.

—> Physical therapy, acupuncture, acupressure or massage therapy can also help in easing pain.

—> For pregnant women, it is important to take extra care with daily activities and movement. It is advisable to replace hazardous furniture, rugs, carpets, and replace them with functional padding and and-rails for additional support.