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<p>Pregnancy- and lactation-associated osteoporosis (PLO) is a rare but potentially debilitating skeletal disorder characterised by fragility fractures, most often vertebral, occurring in the third trimester or, more frequently, in the early post-partum period. Its pathogenesis is multifactorial, combining the physiological peripartum bone loss, mediated by PTHrP, transient oestrogen deficiency and enhanced bone resorption, with predisposing constitutional and nutritional factors and, in a minority of patients, pathogenic variants of WNT-pathway or collagen genes. The hallmark presentation is acute, disabling back pain associated with height loss, a combination that shows high diagnostic accuracy; multiple thoracolumbar vertebral compression fractures are typical, and DXA reveals markedly reduced Z-scores with predominant trabecular involvement. Management is not supported by randomised trials and must be individualised, balancing clinical severity, expected spontaneous recovery and plans for future pregnancies, with options ranging from nutritional and supportive measures to antiresorptive and anabolic agents. This Review summarises current knowledge on the epidemiology, pathophysiology, risk factors, diagnostic work-up and treatment of PLO, underscoring the need for prospective multicentre studies.</p>

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Fragilità scheletrica in gravidanza e allattamento: stato dell’arte, diagnosi e prospettive terapeutiche

  • 期刊论文

  • 发表日期：

    2026年8月3日

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  • Joshua Bemporad,
  • Gaia Tabacco

摘要

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare but potentially debilitating skeletal disorder characterised by fragility fractures, most often vertebral, occurring in the third trimester or, more frequently, in the early post-partum period. Its pathogenesis is multifactorial, combining the physiological peripartum bone loss, mediated by PTHrP, transient oestrogen deficiency and enhanced bone resorption, with predisposing constitutional and nutritional factors and, in a minority of patients, pathogenic variants of WNT-pathway or collagen genes. The hallmark presentation is acute, disabling back pain associated with height loss, a combination that shows high diagnostic accuracy; multiple thoracolumbar vertebral compression fractures are typical, and DXA reveals markedly reduced Z-scores with predominant trabecular involvement. Management is not supported by randomised trials and must be individualised, balancing clinical severity, expected spontaneous recovery and plans for future pregnancies, with options ranging from nutritional and supportive measures to antiresorptive and anabolic agents. This Review summarises current knowledge on the epidemiology, pathophysiology, risk factors, diagnostic work-up and treatment of PLO, underscoring the need for prospective multicentre studies.