Clinical presentation, risk factors and management of pregnancy-associated osteoporosis: a systematic review and meta-analysis

Summary: 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. Introduction: Pregnancy-associated osteoporosis (PAO) is a rare disorder most often presenting with vertebral fractures during pregnancy or postpartum. Aims: 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. Methods: 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. Results: 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. Conclusion: 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.