Low BMI and calcium observed in women with lactation-associated osteoporosis: Frontiers

A new study published in the journal of Frontiers of Endocrinology revealed that low calcium intake, age at pregnancy, prior fragility fractures, the presence of chronic diseases prior to pregnancy, inadequate weight gain, low-molecular-weight heparin (LMWH) use, and low calcium intake during pregnancy are all linked to pregnancy and lactation-associated osteoporosis (PLAO), a condition that has a significant impact on women's health.

Bone fragility is a hallmark of PLAO that frequently manifests as vertebral or other fragility fractures in late pregnancy or the postpartum period. Maternal health, quality of life, and functional independence are all significantly impacted by this disorder. Little is known about the risk factors for PLAO. Thus, this study was set to determine the risk factors for PLAO, both pregnancy-related and unrelated.

For this study, 182 women without PLAO and 155 women with PLAO were given a questionnaire about their pregnancy-related characteristics, lifestyle factors, nutritional practices, and clinical history.

In comparison to women without PLAO (31.6 ± 5.4 years, 13.8%, 5.5%, 2.2%, 2.6%, 50.8%, 6.0%, 0.5%, 11.0%, p<0.05 for all comparisons), women with PLAO were older (32.9 ± 4.7 years), had a higher prevalence of BMI <18.5 Kg/m2 (23.6%), eating disorders (11.6%), amenorrhea (7.1%), chronic diseases associated with bone fragility (11.7%), calcium intake <500 mg/day (66.9%), blue sclerae (5.2%), and had a family history of vertebral/femoral FXs (21.0%).

Pregnancy fragility fractures (odds ratio, OR 2.7, 95% Confidence Interval, CI, 1.199-6.036, p=0.016), chronic diseases (OR 5.8 95% CI, 1.919-17.562, p=0.002), age at pregnancy (OR 1.1, 95% CI, 1.005-1.109, p=0.030), BMI<18.5 Kg/m2 (OR 2.0, 95% CI, 1.042-3.902, p=0.037), and calcium intake <500 mg/day (OR 2.5 95% CI, 1.485-4.166, p=0.01) were all linked to the risk of PLAO.

PLAO women were more likely to have a history of bed rest (21.9%), usage of low-molecular-weight heparin (LMWH, 25.2%), calcium consumption <500 mg/day (67.1%), and inadequate weight growth (49.0%) during pregnancy.

LMWH usage (OR 2.0, 95% CI, 1.124-3.682, p=0.019), inadequate weight growth (OR 1.8, 95% CI, 1.109-3.003 p=0.018), and calcium consumption <500 mg/day during pregnancy (OR 1.5, 95% CI, 1.047-2.141, p=0.027) were linked to an elevated risk of PLAO. Overall, the characteristics that may be evaluated prior to pregnancy and linked to PLAO include underweight, inadequate calcium consumption, age at pregnancy initiation, prior fragility fractures, and the presence of chronic conditions.

Source:

Grassi, G., Zampogna, M., Atlasova, A., Rondinella, S., Ghielmetti, A., Siracusano, G., Chiodini, I., Mantovani, G., & Eller-Vainicher, C. (2025). Identifying risk factors for pregnancy and lactation-associated osteoporosis: insights from an Italian survey in PLAO patients and controls. Frontiers in Endocrinology, 16(1612188). https://doi.org/10.3389/fendo.2025.1612188