World Osteoporosis Day: What Are the Risk Factors After Pregnancy
Pregnancy associated osteoporosis is a rare condition where a woman’s bones break easily during pregnancy or in the weeks after she has given birth. These breaks typically occur in the spine, and sometimes the hip. While this can be painful and debilitating for a time, the bones usually heal quickly and most women recover fully without their daily lives getting hampered. Pregnancy associated osteoporosis is usually short-lived, and most women who have had this condition do not suffer broken bones in later pregnancies. It is still unclear whether women who have had pregnancy associated osteoporosis are more likely to suffer from osteoporosis and broken bones in later life.
What Causes Pregnancy Associated Osteoporosis?
Some women already have low bone density before they conceives, as a result of chronic disease, medications or lifestyle, and the increases in bone metabolism that occur naturally in pregnancy which bring added stresses to the skeleton.
Pregnancy also puts more demands on the skeleton’s ‘calcium bank’. A healthy diet with adequate calcium and vitamin D levels will normally meet this demand, but in a small proportion of women, inadequate calcium and vitamin D may lead to excessive ‘withdrawals’ from the bank and a weakening of the bones during pregnancy .
How is Pregnancy Associated Osteoporosis diagnosed?
Pregnancy related osteoporosis is usually not diagnosed until the birth of the baby. This is because osteoporosis itself generally doesn’t have any symptoms until a fracture occurs, and in pregnancy associated osteoporosis, most fractures occur during or soon after the birth. Back pain is quite common during pregnancy for other reasons, so your doctor may not suspect osteoporosis. X-rays and bone scans that are routinely used to diagnose osteoporosis are usually avoided during pregnancy due to the harmful risk of radiation to the featus. Even after the baby is born, it may take some time to be diagnosed as the pain associated with fracture may be mistaken for post-pregnancy and labour aches. If osteoporosis is suspected after you have given birth, you may have a bone density (DXA) scan to measure the strength of your bones, as well as a normal x-ray to detect any broken bones. You may also need to have other tests to try to find out what has caused the osteoporosis.
Can Pregnancy Associated Osteoporosis be Treated?
Generally, fractures in spinal bones (vertebrae) that occur during or after pregnancy will heal without much medical support. If you have had a spinal fracture then the patient may need to rest for a period to help the fracture heal. If the pain from the fracture is severe, it is important to discuss pain relief with the doctor, so that the patient can start moving about as soon as possible. This is because being immobile for too long can lead to other health problems. If you are apprehensive about taking pain relief medicines while you are breastfeeding, it is a good idea to speak with your doctor about the medicines that are safe for you to use.
Can I Breastfeed?
If you are eating a healthy diet with enough calcium and you are getting enough vitamin D, you are unlikely to need vitamin supplements while you are breast-feeding. However, you may want to discuss with your doctor the possibility of taking calcium and vitamin D supplements if you are concerned about your diet during this time. Breast-feeding has benefits for both mother and baby, and the decision to breast-feed is very personal. It is important to discuss the issues related to breast-feeding and pregnancy associated osteoporosis with the expert so that one can make the best decision.
How Long Will It Take to Recover?
Fracture healing and regaining bone strength takes some time, so it’s important to be patient, and make sure you have enough rest. Symptoms will generally improve two to six months after your baby is born. Spinal bones that have been broken often do not return to their original shape when healed, and this can cause ongoing pain in the surrounding muscles. If you have had a spinal fracture, doing special exercises after your baby is born can help to strengthen your back and reduce pain. It is worth speaking to a physiotherapist about exercises you can do to help. Exercise will help you to recover from your fracture, but it is important to be cautious and take expert advice. It’s also important to realise that your body has gone through a trauma, and that you will need plenty of support and assistance. It may be helpful to speak to your family and friends about getting the help you need.
(Dr Yash Gulati is a senior consultant, Orthopaedics, joint replacement & spine, Indraprastha Apollo Hospitals)
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