Bone Fragility and Fracture Risk During Pregnancy: Insights From REMS-Based Monitoring [ID 1117]

INTRODUCTION: The high calcium demand during pregnancy predisposes women to bone resorption and osteoporosis, with a decrease in BMD ranging from 1% to 9%. This study aimed to evaluate changes in bone quality during pregnancy by monitoring women using the radiofrequency echographic multi-spectrometry (REMS)-based fragility score (FS) and fracture risk (FR) parameters. METHODS: Pregnant women underwent REMS scans at the femoral neck in the first and third trimesters. Changes in FS were assessed using paired t-tests. The 5-year imminent FR was calculated using a REMS algorithm that automatically integrates bone quantity (T-score) and quality (FS) parameters, classifying patients in one of the seven risk categories (R1–R7), each associated with an increased risk of fracture. Logistic regression evaluated the effects of age and body mass index (BMI) on high-risk classification. RESULTS: A total of 52 pregnant women were enrolled. Fragility score increased significantly during pregnancy (+106.73%, from 29.95–52.92 to 33.93–74.59; P =.0066). Notably, 46% of patients shifted risk categories, with 92% of these moving from a lower to a higher risk class (from R1–R4 to R5–R7). Older age at the first trimester was associated with a higher probability of falling into high-risk categories (R5–R7), whereas higher BMI showed a protective trend. CONCLUSIONS/IMPLICATIONS: Radiofrequency echographic multi-spectrometry is a valuable, noninvasive tool with potential for monitoring bone health during pregnancy. Our findings indicate a significant increase in FS and FR, which may reflect changes in bone health and highlight the role of REMS-based FR in identifying women at increased risk who could benefit from targeted preventive strategies.