It's pretty tricky to know if you have osteoporosis or osteopenia (a precursor to osteoporosis signifying low bone density that's less severe), as it's unlikely you will notice any symptoms. In fact, unless you get a bone density scan, you're probably not checking the amount of bone mass you have in the years prior to thinking about conception. Unfortunately, it's definitely something to think about, as having low bone density could affect your ability to safely carry a child and undergo pregnancy without putting your body at risk.
Of course, don't just assume you have osteoporosis or osteopenia. It's pretty rare to be diagnosed with osteoporosis at a young age, but if you have a history of eating disorders or other medical issues, like arthritis or excessive steroid use that could have decreased bone density in the past, it might be worth discussing with your doctor so you can see what complications could arise. Here's what the experts have to say regarding fertility risks and osteoporosis.
What Are the Risks?
If you do have osteopenia or osteoporosis at child-bearing age, although uncommon, you could suffer from bone fractures. "A woman with osteopenia is more likely to suffer a bone fracture than someone with normal bone density and is less likely to have a bone fracture than a woman with osteoporosis," explains Dr. Aaron Styer, gynecologist and endocrinologist, and comedical director of CCRM Boston. "Fractures may be more likely in women with the disease in the hip or spine areas. However, more studies in this area are required to gain a better understanding of these risks."
"Osteoporosis itself does not impair fertility, but in severe cases, women can experience fractures in their spine during pregnancy," fertility specialist Dr. Mark P. Trolice, MD, tells POPSUGAR. "While these are painful, they do not harm the baby." However, in women with severe osteoporosis, even a mild trauma can result in fracture, he says. "Bones can break during delivery of the baby, including those in the spine and the hip," says Dr. Yael Varnado, a physician specialising in women's health. "This can lead to pain, problems with the way you walk, and even cause a curvature of the spine."
Unfortunately, it's impossible to predict the ability of a woman to carry a baby with severe osteoporosis, but physicians may recommend a cesarean section to avoid a pelvic bone fracture, which might occur with a vaginal delivery, Trolice says. Basically, the risks are higher during labor, rather than throughout the pregnancy itself.
"Usually the ligaments that connect the bones in the spine and hips become more relaxed and may stretch more during pregnancy. As a result, a pregnant woman may be at less risk for bone fracture since the bones are less rigid and may be less likely to fracture," explains Styer. "In some cases, the most risk may occur during pushing while in labor, when the connection between the two ends of the pubic bone can separate. There may also be an increased risk of spinal fracture or hip fracture with strenuous activity or lifting."
"Additionally, if the severity of bone loss reduces the ability of the woman to ambulate, the resulting immobilization can increase the risk of a venous thromboembolism (VTE, or blood clot). This condition can be life-threatening, particularly if the clot travels to the heart (heart attack), lungs (pulmonary embolus), or brain (stroke)," Trolice says. However, this is extremely rare.
Still, every patient is different, and depending on the degree of the disease, it's very important to work closely with your ob-gyn during pregnancy to ensure the safety of both mother and baby, midpregnancy and postpregnancy. "Bones can break up to 8-12 weeks following delivery, so stay in tune with your body if you have any changes or start experiencing pain," says Varnado.
Is It Safe?
"Due to the increase relaxation of ligaments connecting the bones of the hip, spine, and pelvis, and the adjustments of the muscles and skeleton, it's usually safe to gain 20-40 pounds during pregnancy," says Styer. Plus, in women with osteoporosis or osteopenia, calcium and vitamin D supplements are essential to prevent additional bone loss, he adds.
Under a physician's direction, you should also reduce heavy lifting or physical activity, which may increase the weight on any isolated bone or bones and increase the risk of fracture, he adds.
The takeaway? Yes, it's safe, but there are greater risks than those without the condition. "Bone density loss in and of itself will not preclude pregnancy. However, if the woman is in severe pain from the bone loss or the disease that's causing osteoporosis contraindicates pregnancy, then it's advisable to pursue surrogacy or adoption," says Trolice. It's really a matter of weighing the risks and seeing what you're most comfortable with. In most cases, you should be able to figure out a plan with your physician.
What If You Experience Fractures?
If you experience fractures either during or after pregnancy, they can be painful and cause limitations in getting around, lifting a baby, and even sitting upright to breastfeed, so be gentle on yourself, says Varnado. "Ask for help from friends, family, and your partner. Keep your cell phone close in case you find yourself in an emergency or fall. And consider physical therapy or occupational therapy to help with pain and also to establish good postural habits," she says.
Exercise can also be a big help, depending on the activity. "Yoga, swimming, and Pilates can be great exercises to strengthen muscles and increase core strength. If you have pain or a fracture, avoid high-impact activities such as running, jumping, and forward-bending exercises — i.e. touching your toes," she says. Plus, if you want to breastfeed and you have osteoporosis, have a talk with your doctor, and make a plan together. "Breastfeeding does cause a decrease in bone density, but it returns to normal once the baby weans," she cautions.