Bone Mineral Density Changes Associated With Pregnancy, Lactation, and Medical Treatments in Premenopausal Women and Effects Later in Life

Abstract

Bone mineral density (BMD) changes during the life span, increasing rapidly during adolescence, plateauing in the third decade of life, and subsequently entering a phase of age-related decline. In women, menopause leads to accelerated bone loss and an increase in fracture risk. Between peak bone mass attainment and menopause, BMD is generally stable and the risk of fracture is typically low. This time period is marked by life events such as pregnancy and lactation, which transiently decrease BMD, yet their long-term effects on fracture risk are less certain. BMD may also be altered by exposure to medications that affect bone metabolism (e.g., contraceptives, glucocorticoids, antidiabetic medications, antiepileptic drugs). Although oral contraceptives are often believed to be neutral with regard to bone health, depot medroxyprogesterone acetate (DMPA) and gonadotropinreleasing hormone (GnRH) agonists have been associated with decreases in BMD. Development of newer medical therapies, principally GnRH antagonists (e.g., ASP1707, elagolix, linzagolix, relugolix), for treatment of endometriosis-associated pelvic pain and heavy menstrual bleeding due to uterine fibroids has renewed interest in the short-and long-term impacts of changes in BMD experienced by premenopausal women. It is important to understand how these drugs influence BMD and put the findings into context with regard to measurement variability and naturally occurring factors that influence bone health. This review summarizes what is known about the effects on bone health pregnancy, lactation, and use of DMPA, GnRH agonists, and GnRH antagonists in premenopausal women and potential consequences later in life. ClinicalTrials.gov identifier: NCT03213457.

Acupuncture for low back and/or pelvic pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials

“…The two types of pain have not been able to be distinguished. Pathologically, pregnant women have increased relaxin produced by both the corpus luteum and the uterine decidua and increased motion in the pelvic joints, which might be the cause of LBPP during pregnancy 6 7. Currently, physical therapy,8 massage therapy9 and special pillows10 are mainly used for LBPP during pregnancy.…”

Osteoporosis, Rather Than Sarcopenia, Is the Predominant Musculoskeletal Disease in a Rural South African Community Where Human Immunodeficiency Virus Prevalence Is High: A Cross-Sectional Study

“…It is unclear whether short-term losses in bone density during pregnancy and lactation fully recover in this population, as they are thought to in high-income settings. ( 36 )…”

Crosstalk within a brain-breast-bone axis regulates mineral and skeletal metabolism during lactation

“…In the NHANES III study, women aged 20–25 years who breastfed as adolescents had higher BMD than their contemporaries who did not breastfeed or were nulliparous ( Chantry et al, 2004 ). Studies looking at long term clinical outcomes mostly show that parity and lactation are not associated with any increase in fracture risk ( Specker and Binkley, 2005 ; Watts et al, 2021 ). However, there may be cultural or genetic differences that modulate whether breastfeeding increases the risk for later osteoporosis.…”