Kovacs C S, Ralston S H
Faculty of Medicine-Endocrinology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada, A1B 3V6,
Osteoporos Int. 2015 Sep;26(9):2223-41. doi: 10.1007/s00198-015-3149-3. Epub 2015 May 5.
In this review, we summarize our current understanding of the pathophysiology of fragility fractures that occur for the first time during pregnancy and lactation, and provide guidance on appropriate investigations and treatment strategies. Most affected women will have had no prior bone density reading, and so the extent of bone loss that may have occurred during pregnancy or lactation is uncertain. During pregnancy, intestinal calcium absorption doubles in order to meet the fetal demand for calcium, but if maternal intake of calcium is insufficient to meet the combined needs of the mother and baby, the maternal skeleton will undergo resorption during the third trimester. During lactation, several hormonal changes, independent of maternal calcium intake, program a 5-10 % loss of trabecular mineral content in order to provide calcium to milk. After weaning the baby, the maternal skeleton is normally restored to its prior mineral content and strength. This physiological bone resorption during reproduction does not normally cause fractures; instead, women who do fracture are more likely to have additional secondary causes of bone loss and fragility. Transient osteoporosis of the hip may affect one or both femoral heads during pregnancy but it involves localized edema and not skeletal resorption. Case reports have described the use of calcitonin, bisphosphonates, strontium ranelate, teriparatide, vertebroplasty, and kyphoplasty to treat post-partum vertebral fractures. However, the need for such treatments is uncertain given that a progressive increase in bone mass subsequently occurs in most women who present with a fracture during pregnancy or lactation.
在本综述中，我们总结了目前对妊娠和哺乳期首次发生的脆性骨折病理生理学的理解，并就适当的检查和治疗策略提供指导。大多数受影响的女性之前没有进行过骨密度检测，因此妊娠或哺乳期可能发生的骨质流失程度尚不确定。在怀孕期间，肠道钙吸收量会增加一倍，以满足胎儿对钙的需求，但如果母亲的钙摄入量不足以满足母婴的综合需求，母亲的骨骼将在孕晚期发生骨质吸收。在哺乳期，一些与母亲钙摄入量无关的激素变化会导致小梁骨矿物质含量损失5%-10%，以便为乳汁提供钙。在给婴儿断奶后，母亲的骨骼通常会恢复到之前的矿物质含量和强度。生殖过程中的这种生理性骨质吸收通常不会导致骨折；相反，发生骨折的女性更有可能有其他导致骨质流失和脆性增加的继发原因。妊娠期间，髋部短暂性骨质疏松可能会影响一个或两个股骨头，但它涉及局部水肿而非骨骼吸收。病例报告描述了使用降钙素、双膦酸盐、雷奈酸锶、特立帕肽、椎体成形术和后凸成形术来治疗产后椎体骨折。然而，鉴于大多数在妊娠或哺乳期发生骨折的女性随后骨量会逐渐增加，这种治疗的必要性尚不确定。
