Pregnancy and lactation associated osteoporosis- An updated narrative review of therapeutic options

Pregnancy and lactation associated osteoporosis (PLO) is a rare but clinically significant cause of fragility fractures in late pregnancy and the postpartum period. Management is not standardized and relies largely on case series, case reports, and small observational cohorts. To provide an updated narrative synthesis of available evidence (published literature to ۲۴ November ۲۰۲۵) regarding therapeutic interventions for PLO, focusing on effects on bone mineral density (BMD), clinical outcomes, and safety considerations relevant to women of childbearing potential.We performed a structured literature search of PubMed/Medline and Scopus (through ۲۴ Nov ۲۰۲۵) to identify systematic reviews, meta-analyses, observational studies, case series, and case reports that evaluated treatments for PLO. Key therapeutics examined include conservative measures (weaning, calcium/vitamin D), antiresorptives (bisphosphonates, denosumab), anabolic agents (teriparatide, romosozumab), and adjunctive/supportive measures (analgesia, physical rehabilitation).The most comprehensive systematic review and meta-analysis available (Anagnostis et al.) synthesized data from multiple small studies and case reports and reported that teriparatide produces larger increases in lumbar spine and femoral neck BMD compared with calcium/vitamin D alone, but high heterogeneity and limited comparative data undermine definitive recommendations. Bisphosphonate case series report marked increases in spinal BMD, whereas case reports/series for teriparatide report consistent BMD gains and clinical improvement; emerging reports describe successful use of denosumab and romosozumab in individual cases. Safety concerns for future pregnancy (drug half-life, skeletal retention, potential fetal exposure) influence therapeutic choice. Evidence for any single optimal therapy remains limited and largely observational. Teriparatide and bisphosphonates have the strongest signals for BMD improvement; denosumab and romosozumab are promising but supported mainly by case reports. Treatment should be individualized, prioritize cessation of lactation when feasible, ensure adequate calcium/vitamin D repletion, and weigh fertility plans. Well-designed multicenter registries and prospective cohort studies are required. Keywords: Pregnancy and lactation associated osteoporosis, bone mineral density, bisphosphonates,  teriparatide, denosumab, romosozumab, lactation cessation

کلیدواژه ها:

Pregnancy- and Lactation-Associated Osteoporosis ، Bone mineral density ، PLO ، Teriparatide ، Bisphosphonates ، denosumab ، Romosozumab ، lactation cessation