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Meta-Analysis
. 2024 Feb 20;109(3):879-901.
doi: 10.1210/clinem/dgad548.

Comparative Effectiveness of Therapeutic Interventions in Pregnancy and Lactation-Associated Osteoporosis: A Systematic Review and Meta-analysis

Panagiotis Anagnostis  1 , Kalliopi Lampropoulou-Adamidou  2 , Julia K Bosdou  3 , Georgios Trovas  2 , Petros Galanis  4 , Efstathios Chronopoulos  2 , Dimitrios G Goulis  1 , Symeon Tournis  2
Affiliations
Meta-Analysis

Comparative Effectiveness of Therapeutic Interventions in Pregnancy and Lactation-Associated Osteoporosis: A Systematic Review and Meta-analysis

Panagiotis Anagnostis et al. J Clin Endocrinol Metab. .

Abstract

Context: The optimal management of pregnancy and lactation-associated osteoporosis (PLO) has not been designated.

Objective: To systematically review the best available evidence regarding the effect of different therapeutic interventions on bone mineral density (BMD) and risk of fractures in these patients.

Methods: A comprehensive search was conducted in PubMed/Scopus databases until December 20, 2022. Data were expressed as weighted mean difference (WMD) with 95% CI. The I2 index was employed for heterogeneity. Studies conducted in women with PLO who received any antiosteoporosis therapy were included. Studies including women with secondary causes of osteoporosis or with transient osteoporosis of the hip were excluded. Data extraction was independently completed by 2 researchers.

Results: Sixty-six studies were included in the qualitative analysis (n = 451 [follow-up time range 6-264 months; age range 19-42 years]). The increase in lumbar spine (LS) BMD with calcium/vitamin D (CaD), bisphosphonates, and teriparatide was 2.0% to 7.5%, 5.0% to 41.5%, and 8.0% to 24.4% at 12 months, and 11.0% to 12.2%, 10.2% to 171.9%, and 24.1% to 32.9% at 24 months, respectively. Femoral neck (FN) BMD increased by 6.1% with CaD, and by 0.7% to 18% and 8.4% to 18.6% with bisphosphonates and teriparatide (18-24 months), respectively. Meta-analysis was performed for 2 interventional studies only. Teriparatide induced a greater increase in LS and FN BMD than CaD (WMD 11.5%, 95% CI 4.9-18.0%, I2 50.9%, and 5.4%, 95% CI 1.2-9.6%, I2 8.1%, respectively).

Conclusion: Due to high heterogeneity and lack of robust comparative data, no safe conclusions can be made regarding the optimal therapeutic intervention in women with PLO.

Keywords: bone mineral density; fractures; lactation; osteoporosis; pregnancy.

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Figures

Figure 1.
Figure 1.
Flowchart diagram.
Figure 2.
Figure 2.
The effect of therapeutic interventions on lumbar spine (LS) (A) and femoral neck (FN) (B) bone mineral density (BMD) in women with pregnancy and lactation-associated osteoporosis. BPs, bisphosphonates; CaD/Ca, calcium plus vitamin D/calcium; CAL, calcitonin; Dmab, denosumab; STR, strontium ranelate; TPD, teriparatide; VitK, vitamin K.
Figure 3.
Figure 3.
Forest plot of the comparative effect of teriparatide or calcium plus vitamin D (CaD) on lumbar spine bone mineral density (BMD) in women with pregnancy and lactation-associated osteoporosis.
Figure 4.
Figure 4.
Forest plot of the comparative effect of teriparatide or calcium plus vitamin D (CaD) on femoral neck bone mineral density (BMD) in women with pregnancy and lactation-associated osteoporosis.
See this image and copyright information in PMC

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