Pregnancy and Lactation Associated Osteoporosis of the Hip: A Systematic Review

Abstract During pregnancy and lactation, changes in mineral metabolism provide fetuses with sufficient calcium. Eith a reported instance of 4–400 per 1 million pregnancies, the decrease in bone mineral density causes pregnancy and lactation associated osteoporosis (PLO). This the first systematic review conducted on this condition affecting the hip. A comprehensive literature search of the databases Embase, PubMed, and Web of Science was conducted. The articles included for review were case studies or case series that consisted of pregnant patients with PLO of the hip. Data extraction was performed on the resulting 64 studies, totaling 149 patient cases. The average age reported was 33.5 years, with an average BMI of 26.5 kg/m 2 and an average height of 165.8 cm. Symptom onset was reported in 50% of cases, 69% in the 3rd trimester, 25% in the 2nd trimester, and 4% in the postpartum period. The route of delivery was a cesarean section in 44% of cases, vaginal delivery in 33%, and unreported in 23%. Treatment included modified weight-bearing (40%), vitamin D and/or calcitriol (26%), and surgery (26%). Cesarean section in patients with PLO occurred at a greater percentage (44%) when compared to the rate of cesarean section in the United States in 2023 (32.1%). This could have implications for the health of the mother and the fetus. The majority of cases occurred during pregnancy. This may complicate the diagnosis and care of the patient. The absence of metabolic disease workup details in these cases is an area for future research and clinical focus.