This position statement from six major professional societies reviews the current evidence on pregnancy- and lactation-associated osteoporosis (PLO), covering diagnosis, assessment, and treatment of fragility fractures (most commonly vertebral) occurring in late pregnancy or early postpartum.
Preferred first-line pharmacological agents are teriparatide/abaloparatide or romosozumab; second-choice options are denosumab followed by bisphosphonates or bisphosphonates alone — all used off-label. Calcium/vitamin D, considering stopping breastfeeding, and analgesia are first-step management. Bisphosphonates cross the placental barrier and persist in bone for years, so adverse effects on future pregnancies cannot be excluded.
PLO is rare, so controlled comparative clinical trials are lacking; most evidence is from individual case series or small studies. All pharmacological treatments for PLO are off-label. Adverse effects of bisphosphonates on future pregnancies have not been reported but cannot be ruled out.
For women with PLO, start with calcium/vitamin D supplementation, analgesia, and consider stopping breastfeeding; if bone-specific therapy is needed, prefer teriparatide, abaloparatide, or romosozumab over bisphosphonates, and ensure effective contraception during treatment. Always perform individualized risk assessment and rule out secondary causes of osteoporosis before initiating pharmacological therapy.
