Osteoporosis del embarazo

Abstract

This article reviews the association between osteoporosis and pregnancy, as well as the two forms found in clinical practice. This association has been poorly investigated, the information arising from isolated clinical cases or from case series. Two, possibly related, forms are described in pregnancy: systemic and regional osteoporosis. The former mainly affects trabecular bone, while the latter affects load territories, frequently the hip. The pathophysiology is unknown, but probably differs in each case. Nonetheless, in both entities there is a common base of susceptibility, with osteopenia or osteoporosis. The rationale for the systemic form is based on current knowledge of the modifications of bone metabolism in pregnancy, when there is a significant increase in vitamin D, and minor changes in other potent modulators, such as parathyroid hormone.

Regional osteoporosis is similar in semiology and progression to severe diseases, such as avascular necrosis, and a similar mechanism in which regional osteoporosis would only be a stage in progression cannot be discarded. There is a scattered increase of resorption, which creates multiple regions of fragility where microfractures accumulate and bone fragility increases. Diagnosis requires clinical suspicion, which should lead to correct diagnosis in both forms. Treatment is symptomatic and, if possible, is based on the release of load. The use of anti-resorptives, and particularly of bisphosphonates, is limited during pregnancy, since these drugs pass the placenta. In both forms, restitution is progressive and relatively rapid after delivery.