Orhadje Elizabeth, Makaram Navnit, Berg Kathryn, Hauser Barbara, Ralston Stuart H
Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK.
Rheumatic Diseases Unit, Western General Hospital, NHS Lothian, Edinburgh, UK.
Osteoporos Int. 2025 Jun;36(6):981-993. doi: 10.1007/s00198-025-07479-0. Epub 2025 Apr 9.
A systematic review and meta-analysis of the presentation, risk factors and treatment response of pregnancy-associated osteoporosis was conducted involving 35 studies and 943 patients. Vertebral fractures, back pain and family history of osteoporosis were common features. Analysis of treatment response was inconclusive due to limited availability of data.
Pregnancy-associated osteoporosis (PAO) is a rare disorder most often presenting with vertebral fractures during pregnancy or postpartum.
This meta-analysis aimed to evaluate the presenting features of PAO, its risk factors and the effectiveness of various treatments at improving bone mineral density (BMD) and preventing further fractures.
A systematic search of PubMed, EMBASE and Web of Science identified 35 studies comprising 943 cases of PAO. A meta-analysis was conducted to evaluate the effect of treatment on change in BMD at the lumbar spine, femoral neck and total hip.
Vertebral fractures and back pain occurred in 89.2% and 90.2% of cases, respectively. The diagnosis was predominantly made postpartum. The most common risk factor was a family history of osteoporosis (40.5%). Calcium and vitamin D supplements (31.8%) and teriparatide (30.8%) were the most commonly used treatments. The meta-analysis of BMD response was inconclusive due to limited availability of data. The BMD change at the lumbar spine was greater with teriparatide compared with calcium/vitamin D and bisphosphonates but this was based on only two studies. There was no difference in BMD response at the femoral neck. Recurrent fractures were reported in 12.9% with no difference between treatment groups.
While this review can assist clinicians with the diagnosis and management of PAO, it highlights some key knowledge gaps that may inform conduct of a Delphi process on the diagnosis and management of this disorder, pending conduct of randomised controlled trials.
对妊娠相关性骨质疏松症的表现、危险因素及治疗反应进行了系统评价和荟萃分析，纳入35项研究共943例患者。椎体骨折、背痛和骨质疏松症家族史是常见特征。由于数据有限，对治疗反应的分析尚无定论。
妊娠相关性骨质疏松症（PAO）是一种罕见疾病，最常表现为妊娠期间或产后的椎体骨折。
本荟萃分析旨在评估PAO的表现特征、危险因素以及各种治疗方法在改善骨密度（BMD）和预防进一步骨折方面的有效性。
对PubMed、EMBASE和Web of Science进行系统检索，确定了35项包含943例PAO病例的研究。进行荟萃分析以评估治疗对腰椎、股骨颈和全髋部BMD变化的影响。
分别有89.2%和90.2%的病例发生椎体骨折和背痛。诊断主要在产后做出。最常见的危险因素是骨质疏松症家族史（40.5%）。钙和维生素D补充剂（31.8%）和特立帕肽（30.8%）是最常用的治疗方法。由于数据有限，对BMD反应的荟萃分析尚无定论。与钙/维生素D和双膦酸盐相比，特立帕肽治疗后腰椎的BMD变化更大，但这仅基于两项研究。股骨颈的BMD反应无差异。据报告，12.9%的患者出现复发性骨折，各治疗组之间无差异。
虽然本综述可为临床医生诊断和管理PAO提供帮助，但它突出了一些关键的知识空白，这可能为在进行随机对照试验之前开展关于该疾病诊断和管理的德尔菲过程提供参考。
