Natalie\ is a 32-year-old attorney from Cape Town South Africa.  She gave birth to her third baby in October 2022 and has three children, age 9, age 2 and 6 months.

When she was 5 months pregnant (and 3 weeks after her husband had surgery on his spine/neck) she woke up not being able to walk properly, with immense pain and a heavy limp. Since the pain was deep in her lower back and upper thigh, she assumed it was sciatica, but after a week decided to consult a physiotherapist, who ruled out sciatica. This was later also confirmed by a neurologist.  An MRI at 27 weeks confirmed she had a fracture in her sacrum.

She was baffled since she had not fallen or experienced trauma. At first, she was quite concerned as the neurologist had to rule out any growths or possible cancer. X-rays and a further MRI confirmed no growth, just water fluid and a fracture. 3 Months bed rest was recommended and support through crutches.

Natalie shares that this was a very dark and lonely chapter for her, being forced to bed rest and not being able to play with her toddler.  She continued to have intense pain, and couldn’t move in her sleep without agony, as the baby was pushing on her pelvis, making the pain worse. Due to her pregnancy, she could not take any medication besides paracetamol, which did nothing for the pain.  She opted to have a natural birth, not knowing that natural birth probably wasn’t a safe option.

She suspected that she might have fractured a vertebra shortly after birth as she was again in immense pain, and had fire-like feelings down her back through spasms.  Four weeks postpartum she had a bone density scan and her orthopedic specialist was shocked at the results.

Says Natalie: “I had the bones of a very old lady. I have osteoporosis in my lower spine and hips, and osteopenia in my femur. I have no family history of osteoporosis. I went to an endocrinologist and had many blood tests done. Everything came back absolutely normal. I was then diagnosed with pregnancy-induced osteoporosis.”

She felt very overwhelmed and was advised to stop breastfeeding her newborn and toddler immediately. Giving up such a special part of motherhood was incredibly difficult, but she was advised she could lose further bone otherwise. She started taking Forteo, a daily injection, which promotes bone growth and struggled to find local people who share her condition.  It’s been painful for her,  as she cannot hold her baby for long without pain, and can’t lift heavy things. The risk of further fractures is great, and her treatments leave her feeling very tired and ill. Still young, she pushes through knowing that she has to improve the condition of her bones.

Osteoporosis associated with pregnancy is a very unusual situation when bones break suddenly or severe pain occurs during or soon after pregnancy in otherwise
apparently healthy women.  It is a rare condition when bones break (fracture) easily, usually in the spine, or occasionally the hip, around the time a woman is giving birth, causing pain and disability. These broken bones heal in the normal way and usually, women recover and return to their previous quality of life.

However, when bones break it can be frightening and confusing for the women affected, and their families. If pregnancy-associated osteoporosis has affected
you, then you may have a number of questions in your mind:

  • Why did my bones lose strength and break?
  • Should I have medical treatment?
  • Can I have more babies?
  • Should I breastfeed?
  • How can I prevent this from happening in another pregnancy?
  • Will I be affected by osteoporosis and fractures when I am older?

Various explanations have been put forward.  It has not been shown in research studies that having low bone density prior to pregnancy will result in faster bone loss or fractures during or after pregnancy.

Osteoporotic fractures associated with pregnancy are rare and often go unrecognised. Back pain in pregnancy for other reasons is very common and doctors are reluctant to use x-rays during pregnancy because this will expose the baby to radiation. Therefore, little progress towards diagnosis is usually made until after the baby is born.
If severe pain continues after you have given birth, you may need to persevere to find out what is wrong.

The following investigations may be useful if osteoporosis associated with pregnancy is suspected. Your doctor may decide that one or more tests are appropriate.

• X-rays will show if bones are broken.
• Bone density scanning (DXA) will give some information about bone strength.
• Blood tests may be needed to confirm you do not have an underlying health problem which may have caused osteoporosis.
• A radioisotope scan will show up ‘hot spots’ in the body where there may be fractures.
• MRI (magnetic resonance imaging) does not involve x-rays. It is used to look at soft tissue such as the discs (shock absorbers) between the spinal bones. Sometimes, damage to discs can cause pain. This is not osteoporosis.

These tests help your doctor to understand if fractures are causing your pain and, if so, whether osteoporosis is the reason they have occurred. If osteoporosis is diagnosed, this does not mean the fractures are any more serious or will not heal. For most women, fractures do not keep occurring and they do get better.

For more information on this condition and how to get help download this brochure from the National Osteoporosis Society.