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. 2021 Nov 3;22(1):926.
doi: 10.1186/s12891-021-04776-7.

Pregnancy- and lactation-associated osteoporosis with vertebral fractures: a systematic review

Ying Qian  1 , Lei Wang  2 , Lili Yu  3 , Weimin Huang  4
Affiliations

Pregnancy- and lactation-associated osteoporosis with vertebral fractures: a systematic review

Ying Qian et al. BMC Musculoskelet Disord. .

Abstract

Background: To review, analyze and characterize the pregnancy and lactation-related osteoporosis (PLO) with vertebral fractures based on the extraction data in the previous studies.

Methods: A comprehensive literature search of electronic databases including the PubMed, Embase and Web of Science was conducted from January 1st,1990 to December 1st, 2020. The enrolled data were pooled to analyze the baseline characteristics, clinical features, risk factors and treatment options.

Results: A total of 65 articles with 338 cases were enrolled for data extraction. The enrolled cases aged from 19 to 47 years, with a mean value of 35.7 years old. The average body mass index (BMI) was 22.2 kg/m2 ranged from 16.0 to 39.0 kg/m2. Of the 173 cases, 149 cases with vertebral fractures occurred in the first pregnancy, 19 cases in the second pregnancy, four cases in the third pregnancy and one case in the fourth pregnancy. Up to 91.5% of the back pain occurred within the last 3 months of pregnancy and the first 3 months after delivery. The most involved vertebral levels were L2, L1 and T12 accounting for 32.6% of all the fractures. The average fracture numbers were 4.4 levels per patient. The lumbar Z-scores were mostly recorded with a mean value of - 3.2 ranged from - 7.8 to 0.

Conclusions: PLO with vertebral fractures is a rare clinical entity, which is more likely to occur in older and thinner pregnant women. Back pain is the clinical complaint and mostly occurs in the late pregnancy and early lactation periods. Most vertebral fractures appear in the first pregnancy but it can occur in any time of pregnancy. Thoracolumbar region is the mostly involved region. As compared with postmenopausal osteoporotic fractures, PLO usually has multiple levels fractures. Bisphosphonates are the most widely used treatment so far, however, many factors need to be taken into account to decide which drug to choose in PLO and further studies are necessary for clear recommendation in the future.

Keywords: Lactation; Osteoporosis; Pregnancy; Systematic review; Vertebral fractures.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The flow diagram of included and excluded studies
Fig. 2
Fig. 2
The age distributions of the included population
Fig. 3
Fig. 3
The BMI distributions of the included population
Fig. 4
Fig. 4
Symptom onset time of the included patients
Fig. 5
Fig. 5
The fractured site of the included population
See this image and copyright information in PMC

References

    1. Kyvernitakis I, Reuter TC, Hellmeyer L, Hars O, Hadji P. Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up. Osteoporosis Int. 2018;29:135–142. doi: 10.1007/s00198-017-4239-1. - DOI - PubMed
    1. Laroche M, Talibart M, Cormier C, Roux C, Guggenbuhl P, Degboe Y. Pregnancy-related fractures: a retrospective study of a French cohort of 52 patients and review of the literature. Osteoporosis Int. 2017;28:3135–3142. doi: 10.1007/s00198-017-4165-2. - DOI - PubMed
    1. Tuna F, Akleylek C, Ozdemir H, Demirbag Kabayel D. Risk factors, fractures, and management of pregnancy-associated osteoporosis: a retrospective study of 14 Turkish patients. Gynecol Endocrinol. 2020;36:238–242. doi: 10.1080/09513590.2019.1648417. - DOI - PubMed
    1. Yun KY, Han SE, Kim SC, Joo JK, Lee KS. Pregnancy-related osteoporosis and spinal fractures. Obstet Gynecol Sci. 2017;60:133–137. doi: 10.5468/ogs.2017.60.1.133. - DOI - PMC - PubMed
    1. Smith R, Stevenson JC, Winearls CG, Woods CG, Wordsworth BP. Osteoporosis of pregnancy. Lancet. 1985;1:1178–1180. doi: 10.1016/S0140-6736(85)92861-2. - DOI - PubMed

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