Pregnancy is a beautiful and transformative journey, but it also brings many physical changes that can affect a woman’s health in unexpected ways. One rare but important condition to be aware of is pregnancy-associated osteoporosis(PLO).

While not commonly discussed, PLO can lead to serious health challenges if left unrecognized or untreated. In this blog, we explore what PLO is, what causes it, how to recognize the signs, and, most importantly, how to protect bone health during and after pregnancy.

How Lifestyle Choices Influence Bone Loss

Your everyday choices significantly impact your bone health. Diet, exercise, and habits like smoking or drinking all play a role. Understanding these factors empowers women to make changes that can protect and strengthen their bones, especially during the physically demanding pregnancy and postpartum recovery phases.

How Does Pregnancy Affect Bone Health?

Pregnancy involves significant changes in your body’s hormone levels and nutritional needs. These changes are necessary to support your growing baby but can also impact your bone health. Estrogen levels fluctuate, calcium demand increases, and your bones undergo accelerated remodeling.

Key impacts on bone health include:

• Increased calcium requirements for fetal bone development
• Elevated estrogen levels, which initially protect bone density
• Accelerated bone remodeling, which may lead to temporary bone loss
• Postpartum calcium depletion due to breastfeeding
• Physical strain from pregnancy weight and posture changes

How Bone Metabolism Changes During Pregnancy and Lactation

Bone metabolism refers to the process of bone formation and resorption. During pregnancy and especially while breastfeeding, your body prioritizes your baby’s needs for calcium and other minerals, sometimes at the expense of your own bone strength. This is a normal and temporary adaptation but can weaken bones if nutritional support is inadequate.

The Relationship Between Bone Density and Fracture Risk

Bone density is a critical indicator of your bone’s strength and durability. During pregnancy, low bone density can make bones more fragile and increase the likelihood of fractures. These fractures often occur in weight-bearing areas like the spine and hips, which are already under extra stress from pregnancy.

What is Pregnancy-Associated Osteoporosis?

Pregnancy-associated osteoporosis is a condition where women experience a significant reduction in bone density during late pregnancy or while breastfeeding. It is typically identified in the third trimester or early postpartum period and can lead to fractures, particularly in the spine and hips. The condition is rare, but for those affected, it can cause chronic pain and mobility issues.

While most women regain their bone density after weaning, PLO can have lasting effects if not appropriately managed. Early recognition and proper care are key to preventing complications.

Factors That Contribute to Osteoporosis During Pregnancy

Even though pregnancy generally supports bone development due to hormonal changes, certain conditions can lead to bone loss instead. The body’s increased demand for calcium to help the baby can sometimes outpace intake or absorption, especially if other risk factors are present. Recognizing these contributing factors is essential for prevention and treatment.

Common contributing factors include:

• Calcium and vitamin D deficiency
• Hormonal imbalances, particularly in estrogen and progesterone
• Pre-existing bone conditions, such as family history of osteoporosis
• Physical inactivity or excessive high-impact activity
• Young maternal age or low body weight
• Chronic illnesses or medications that affect bone metabolism

Recognizing the Symptoms of Pregnancy-Associated Osteoporosis

The symptoms of PLO are often subtle initially, making it easy to overlook. Many women assume that aches and pains are a normal part of pregnancy. However, persistent or severe discomfort may indicate something more serious, such as bone weakening or fractures.

Watch for these common symptoms:

• Persistent lower back, hip, or leg pain

• Sudden fractures with minimal or no trauma

• Decreased mobility and difficulty performing daily tasks

• Loss of height or stooped posture due to spinal compression

• Pain that worsens during breastfeeding

The Consequences of Osteoporosis During Pregnancy

If left unaddressed, pregnancy-associated osteoporosis can lead to serious health issues. Fractures may occur suddenly and impair a woman’s ability to care for her newborn or recover postpartum. Additionally, unresolved bone loss can lead to long-term skeletal weakness.

Potential consequences include:

• Vertebral or hip fractures
• Chronic pain and reduced mobility
• Postural deformities
• Challenges with physical activity and caregiving
• Heightened anxiety or stress due to injury

Understanding the Risk Factors for Pregnancy-Associated Osteoporosis

Knowing your risk factors can help protect your bone health proactively during pregnancy. Women with a history of bone-related conditions or inadequate nutrition may be more susceptible to developing PLO. Age, lifestyle, and health conditions all play a role.

Common Fractures Linked to Pregnancy-Associated Osteoporosis

Certain fractures are more commonly seen in women with pregnancy-associated osteoporosis. These typically involve the spine and lower body, which bear the brunt of weight and physical strain during and after pregnancy.

How Pregnancy-Associated Osteoporosis Affects Future Pregnancies

Experiencing PLO in one pregnancy can raise concerns for future ones. It may require closer monitoring, nutritional planning, and adjustments in physical activity. The emotional impact of a prior diagnosis can also influence how a woman approaches subsequent pregnancies.

 

Diagnosing and Treating Pregnancy-Associated Osteoporosis

Proper diagnosis is crucial to managing PLO effectively. Physicians use imaging and blood tests to assess bone density and identify any abnormalities. Treatment focuses on symptom relief, nutritional support, and, in some cases, medication after delivery.

Strategies to Maintain Bone Health During Pregnancy

The best way to manage pregnancy-associated osteoporosis is to prevent it. By focusing on nutrition, physical activity, and routine healthcare check-ups, expecting moms can support their bones and reduce the risk of complications. These strategies are also beneficial postpartum, especially while breastfeeding.

Ways to maintain bone health:

• Consume calcium-rich foods like dairy, leafy greens, and fortified plant milks
• Get enough vitamin D from sunlight and fortified foods
• Stay active with safe weight-bearing exercises
• Avoid smoking and excessive alcohol
• Discuss supplements with your doctor if needed

Safe Exercises to Support Bone Strength in Pregnancy

Exercise is essential for bone health, but it must be approached with care during pregnancy. Low-impact, weight-bearing movements help strengthen bones without putting too much strain on joints or the growing belly. Always consult your healthcare provider before starting a new routine.

 

Recommended Supplements for Bone Health in Pregnancy

While food should be your first source of nutrients, supplements may be necessary during pregnancy to meet your increased needs. Always consult with your doctor before taking new supplements, especially during pregnancy or breastfeeding.

Summary: Pregnancy-Associated Osteoporosis

Pregnancy-associated osteoporosis is rare but serious. Understanding its causes, symptoms, and management options can empower women to take proactive steps for their health. Whether you’re expecting your first baby or planning another pregnancy, staying informed and working closely with your healthcare provider is the best way to protect your bone health.

A healthy mom means a healthy baby—and that includes strong bones to support both of you through pregnancy, postpartum, and beyond.

 

REFERENCES:

Pregnancy-related osteoporosis and spinal fractures – PMC

What to Know About Osteoporosis During Pregnancy

Pregnancy and Bone Health – Healthy Bones Australia

Pregnancy associated osteoporosis (PAO)

March 22, 2025