Life

Pregnancy-associated osteoporosis (PAO) – what is it and what are the symptoms

The condition affects one in 100,000 people.

Lucy Rose had the bone density of someone of an 110-year-old
Lucy Rose had the bone density of someone of an 110-year-old (David Jensen/EMPICS Entertainment)

English singer-songwriter Lucy Rose said she “couldn’t pick up my baby” after she was diagnosed with a rare form of pregnancy-associated osteoporosis (PAO).

During an interview with the BBC, the 34-year-old shared that after trying to convince healthcare professionals that something was wrong and visiting a chiropractor – who made things worse – her husband decided to pay for a private MRI scan.

The results showed that her bone was broken in eight different places and that she had the bone density of someone who was aged 110.

“I couldn’t pick up my baby, I couldn’t push a pram, I couldn’t even wash my hair,” she told the BBC.

“Every time I’d go in and it was the same thing,” she says. “I’d be yelping in pain, then he’d prod my back and say, ‘There’s nothing wrong here – back pain is part and parcel of having a baby’.

“It got to the point where I was crying, begging for an MRI and the doctor told me I needed to dial it down and I was being over the top.”

Pregnancy-associated osteoporosis (PAO) affects one in 100,000 people and can be very isolating for new mothers. But what exactly is it and what are the symptoms to look out for? Health experts share everything you need to know.

What is pregnancy-associated osteoporosis (PAO)?

According to Kiran Jones, a pharmacist at Oxford Online Pharmacy, pregnancy-associated osteoporosis, also known as pregnancy-and-lactation-associated osteoporosis, is a severe type of bone weakening that happens in women who are pregnant or recently after giving birth.

“This weakening leads to bones breaking, chipping or fracturing, which can happen during day-to-day activities. These fractures occur most commonly in the spine’s bones and less often in the hips.

“We think that for some women, pregnancy triggers an unusual and unexpected change in how bones function in the body. It is also thought that women who already have low bone density pre-pregnancy might develop PAO as normal pregnancy-related bone loss further increases their chance of broken or fractured bones.”

(Alamy Stock Photo)

What are the symptoms?

Patients with PAO often experience sudden-onset, severe back pain, especially in the lower back and spine, with pain worsening with movement or weight-bearing activities such as walking.

“It is also not uncommon for women with PAO to be at an increased risk of experiencing fragility fractures, particularly in the spine, hip, and/or wrist. These fractures can occur with minimal or no trauma, such as from a minor fall or even during routine daily activities,” said Ana Carolina Goncalves, the superintendent pharmacist at Pharmica.

“Additionally, due to vertebral fractures, some women may experience a gradual loss of height over time. Such fractures can lead to changes in posture, resulting in stooping or kyphosis, which refers to excessive curvature of the upper back. Ultimately, the pain and fractures associated with this condition can significantly impair a woman’s ability to move and perform daily activities.”

How does it differ from other osteoporosis conditions?

PAO differs from other more common forms of osteoporosis in several key ways, including its cause, prevalence, onset, severity, fracture risk, and reversibility.

“The primary cause of PAO is believed to be the hormonal changes and increased calcium demands associated with pregnancy and the postpartum period. In comparison, other forms of osteoporosis are often related to factors such as ageing, genetics, lifestyle, and underlying medical conditions, including chronic malnutrition, long-term use of anabolic steroids, hormonal imbalances, and disorders like rheumatoid arthritis or coeliac disease,” said Goncalves.

“It typically develops during the third trimester of pregnancy or within the first year after delivery, whereas other types of osteoporosis are more common in older adults.”

Goncalves explains that PAO is also characterised by a rapid and severe loss of bone mineral density, often resulting in osteoporosis at a relatively young age. In contrast, other types of osteoporosis typically involve a slower, gradual loss of bone density over longer periods.

(Alamy Stock Photo)

“Some women with PAO may have a significantly higher risk of experiencing fragility fractures (particularly in the spine, hip, and/or wrist) compared to people affected by other forms of osteoporosis – although this depends on treatment and management,” she added.

“In some cases, the bone loss associated with PAO can partially or fully reverse after delivery or with appropriate treatment, while other types of osteoporosis are generally less reversible, and the focus is on slowing or preventing further bone loss.”

How is it treated?

For Goncalves, treatment for PAO typically focuses on taking vitamin supplements and medication to improve bone density.

“Calcium, vitamin D, magnesium and omega-3 are all examples of supplements that may potentially contribute to improving overall bone health, given their unique properties,” she said.

“In terms of medication, recent studies suggest that Teriparatide can help counteract the effects of osteoporosis as it contains a hormone called parathyroid, which can help the body control blood calcium levels. The resulting increase in bone mass density can help prevent vertebral and hip fractures in pregnant women.

“It is worth noting that another type of medication called ‘bisphosphonates’, which has traditionally been prescribed to help treat osteoporosis, is not recommended for pregnant women.

“Although it can inhibit the activity of cells that break down bone tissue, it can also cross the placenta during pregnancy, posing a potential risk to the foetus.

“Moreover, biphosphonates have a long half-life, so taking them while pregnant is likely to cause prolonged exposure to the foetus throughout pregnancy, affecting foetal bone development.”

(Alamy Stock Photo)

What is the recovery rate?

PAO recovery rates vary depending on the type of treatment administered, the severity of symptoms, and the individual’s unique physiology.

“Teriparatide, for example, has been shown to rapidly increase bone mass density among pregnant individuals even if taken several months after the onset of PAO. As a result, individuals taking this treatment can expect symptoms to subside and their condition to improve at a faster rate than those taking alternative treatments such as vitamin and mineral supplements,” said Goncalves.

“Some individuals with more severe osteoporosis may require long-term care even after pregnancy, suggesting that the condition may be something you have to live with for an extended period. The fact that our bone density naturally decreases with time can potentially compound this effect, therefore warranting an increased level of care over time.”

What can you do to ease it?

“Prevention and awareness are better than treatment, so if a woman already has a history of osteoporosis or weak bones, themselves or in their family, they should make sure to discuss it at their first midwife appointment,” said Jones.

“Good calcium intake from dairy sources and leafy green vegetables helps keep bones strong as well as Vitamin D.”