2023-10-16 08:08:25
by Elena Meli
Loss of bone density during pregnancy affects one in 100,000 women. It is important to intercept the symptoms. Bones are brittle and break, and the weakness may remain even after giving birth. Here’s what to do
Fragile bones, which break under the weight of the belly: osteoporosis in pregnancy is rare, but it is important to diagnose and manage it before it causes one or more fractures, during the wait and even after.
How many are at risk
Because, women with osteoporosis and fractures during pregnancy then fracture again, perhaps when they are breastfeeding or the children are small, in a period in which they cannot afford to feel ill or not be able to hold their child in their arms, explains Maria Luisa Brandi, president of the Firmo Foundation (Italian Research Foundation on Bone Diseases). Also for this reason, on the occasion of World Osteoporosis Day on 20 October, Firmo organized a conference in which ample space will be given to osteoporosis during pregnancy, to shine the spotlight on a problem that women, but also gynecologists, know little. Estimates speak of one case in 100 thousand women but it is likely that the real numbers are much higher precisely because many do not know that they have fragile bones: few people think of severe back pain at the end of nine months or during breastfeeding. it may depend on a vertebral compression fracture, the most common among these patients, which generally fracture during the first pregnancy and then, up to 1 in 3, also in subsequent ones.
Symptoms
The typical sign of osteoporosis during pregnancy, in fact, is pain: it can be disabling, but doctors or even women themselves hardly think that the cause could be an osteoporotic fracture, which occurs without there having been trauma. Very severe back pain in the third trimester or in the first months after giving birth, which persists, does not go away and which worsens with movement, should make you suspicious if you have risk factors for osteoporosis, and the same goes for pain at the hip or femur level, which may depend on transient osteoporosis of the femur and usually intensify with load and decrease at rest. As underlined by the patients of the association Mothers with Pregnant Osteoporosis (Mamog), who participate in the day of in-depth analysis of the Firmo Foundation and on website www.mamog.it they give information to help women understand the problem and clarify doubts, sometimes minimal twists are enough to fracture, even just picking up or placing the baby in the cradle: the pain is therefore often associated with the frustration of not being able to look after a child as one would he would.
The bone loss serves to transfer calcium to the baby
During gestation, physiological bone loss occurs, especially after the embryonic phase and when there is calcification of the fetus’ bones, in the third trimester: at the end of pregnancy the maternal bone mass clearly decreases also because the transfer of calcium to the baby increases (in total approximately 20-30 grams from the beginning of gestation until the moment of birth). Even during breastfeeding, the mother passes about 200-250 milligrams of calcium per day to the newborn and depletes the bone, with a reduction in density from 3 to 9%, which is then recovered in 3-6 months from when she stops. to breastfeed. This normally happens in all women, but if the starting condition is a more fragile bone, pregnancy can lead to a risk of fractures due to the low density of the bone, which breaks even with minimal stress.
The predisposition
Women with osteoporosis during pregnancy need to be identified and treated, or they will fracture again, Brandi says. There is a genetic predisposition, three mutations leading to fragility have been identified. But there are also elements of the woman’s history connected to a greater probability of pregnancy osteoporosis, such as having had prolonged amenorrhea (menstrual cycle disappeared for months, ed.), eating disorders, previous fractures in childhood, low weight or poor weight gain in pregnancy: women with these risk factors should be monitored more closely, for example by subjecting them to a special type of ultrasound of the spine and femur which offers results comparable to a Dexa, the classic bone densitometry.
How to preserve bones
The questionnaire To investigate the probability of fractures in women of childbearing age – continues Brandi – we have also developed a risk map that we are validating in a large study on approximately three thousand women: it is a simple questionnaire with 20 questions to answer during the first trimester of pregnancy, which could help identify pregnant women to be monitored or subjected to further investigation. Equally useful is the 25-question questionnaire to evaluate your calcium intake, because during the months of waiting and while breastfeeding your requirement increases and make sure you stock up on this even more essential mineral if you suffer from osteoporosis. Because the good news is that something can be done if when you are expecting a baby you discover that you have fragile bones: First of all, the levels of calcium, vitamin D and some hormones with a role in bone metabolism (such as calcitonin and parathyroid hormone, ed.); then, you must avoid moving weights and also taking heparin, a drug used to prevent miscarriage and for an acute cause of osteoporosis, explains Brandi. Furthermore, a caesarean section in the seventh or eighth month is indicated because the risk of fracturing during childbirth is significant, while breastfeeding must continue for a minimum time, no longer than one month. All this serves to avoid fractures during the current pregnancy but also subsequently: women with pregnancy osteoporosis are at high risk for the rest of their lives, therefore once identified they must be followed and treated so that they do not lose bone mass.
October 16, 2023 (modified October 16, 2023 | 08:08)
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