Bone Abstracts

Pregnancy and lactation associated osteoporosis (PLO) is a rare condition of fragility fractures occurring in association with markedly reduced bone mineral density during pregnancy or the early postpartum period. Vertebral fractures are the hallmark of the condition, with several fractures typically present by the time of diagnosis¹. Women with vertebral fractures due to PLO generally report severe pain and mobility limitation, making it challenging to care for their newborn babies². Affected women also frequently experience diagnostic delay due to a lack of awareness of the condition among clinicians^1,3. The optimal management of PLO osteoporosis is currently unclear; there are no published clinical guidelines, and the literature comprises case reports, case series and observational studies. In particular whether, and at what point, women diagnosed with pregnancy associated osteoporosis should be treated with osteoporosis medications is debated⁴, and no randomised clinical trials of pharmacological treatment have been undertaken to date. This talk will cover how to recognise and investigate PLO, and considerations around treatment including supportive care, advice on breastfeeding and lifestyle measures, and the potential role of medications with reference to recently published systematic reviews and meta-analyses^5,6.

1. Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I. Pregnancy-associated osteoporosis: A case-control study. Osteoporos Int. 2017;28:13931399.

2. Gehlen M, Lazarescu AD, Hinz C, et al. Long-term outcome of patients with pregnancy and lactation-associated osteoporosis (PLO) with a particular focus on quality of life. Clin Rheumatol. 2019;38:35753583.

3. Condon SB, Veitch M. The experience of pregnancy associated osteoporosis: An international survey with implications for midwifery care. Midwifery. 2022;115: 103468.

4. Kovacs CS. Complex clinical encounter series: Osteoporosis presenting during pregnancy and lactation: Wait and reassess. J Bone Miner Res. 2024;39:197201.

5. Orhadje E, Makaram N, Berg K, Hauser B, Ralston SH. Clinical presentation, risk factors and management of pregnancy-associated osteoporosis: A systematic review and meta-analysis. Osteoporosis International. 2025;36:981993.

6. Issa Z, Saad R, Ammar S, et al. Pregnancy and lactation associated osteoporosis: A systematic review. Calcified Tissue Int. 2026;117(42) doi: https://doi.org/10.1007/s00223-026-01499-6.