Osteoporosis during pregnancy and its management.

Osteoporosis leading to fracture can occur during pregnancy. Bone density may be low before pregnancy due to recognised causes such as coeliac disease, osteogenesis imperfecta and previous anorexia nervosa (secondary osteoporosis). In some patients there is no identifiable cause. This condition is referred to as "pregnancy associated or pregnancy related osteoporosis"; it is not known whether pregnancy causes the osteoporosis or merely coincides with it. Typically the loss of bone leads to vertebral fracture with loss of height or pain in the hips also sometimes with fracture. Symptoms most often begin in the third trimester of the first pregnancy and improve after delivery; they do not usually recur in subsequent pregnancies. The cause is unknown and there is no specific treatment; follow up bone density measurements show that the osteoporosis slowly improves post partum. Recent research in non osteoporotic women shows that breast feeding maintains a low bone density; it is therefore contraindicated in pregnancy associated osteoporosis.