The Bone Matter

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While it’s rare, osteoporosis leading to fracture can occur during pregnancy. What does this mean for you?



Good health and lifestyle habits can greatly minimise the risk for osteoporosis. Considering that bone is living tissue, just like the rest of the body, it is likely that what you put in your mouth will determine in part how strong your bones will be.


What is Osteoporosis?

Osteoporosis is a bone disease where there is progressive “thinning” of the bone beyond a certain limit which causes increased susceptibility to getting a fracture.

It is loss of bone quantity and quality, explains Dr Chua Yang a consultant obstetrician and gynaecologist at A Clinic for Women. The quantitative definition of osteoporosis is when the T-score (a measure of bone density compared to a person with peak bone mass) is -2.5 or lower.


Are You at Risk?

It is very unusual for women in the pre-menopausal age to get osteoporosis. However, we consider osteoporosis as a geriatric disease with paediatric origin, explains Dr Chua Yang. That is to say that the set up for osteoporosis is a continuous process starting from childhood. Kids set themselves up for osteoporosis in later years if they do not exercise, stay active or have calcium deficiency because they do not like or tolerate milk and other dairy products, says Dr Chua Yang.               

During pregnancy, women lose calcium to their babies. According to Joanne Todd, a senior health platform manager for Fonterra Brands Limited, getting enough calcium is a key factor in the prevention of osteoporosis. Calcium is essential to maintain the level of bone mass your body needs to support its structure. When your diet is low in calcium, your body takes calcium from your bones to use in other parts of the body, and over time bone density declines and bones become weak, Todd further explains. Sources of calcium include milk and milk products, green vegetables, fish with soft edible bones, calcium set tofu and certain fruits and nuts, and 1,000mg of calcium should be consumed each day.

Vitamin D helps calcium get into the blood stream to help build strong bones. By exposing your skin to sunlight for 10 to 20 minutes each day, your skin will produce enough vitamin D in response to the UV rays. Alternatively, you can get vitamin D through your diet by eating oily fish such as salmon and tuna, as well as cod liver oil, eggs and fortified foods such as milks and cereals.              

Besides a healthy diet, exercise is just as important and weight-bearing exercise is good for building strong bones. During weight-bearing exercise, the bone adapts to the impact of weight and the pull of muscle by building more bone cells – resulting in stronger and denser bones.               

Osteoporosis risk increases as you age. After maximum bone density and strength is reached (generally around age 30), bone mass begins to naturally decline with age.              

In addition, says Todd, there are several groups of people who are more at risk of developing osteoporosis due to their decreased ability to efficiently absorb calcium. One such example is menopausal women.              

Post-menopausal women may start to experience oestrogen deficiencies, resulting in an increased loss of calcium from bones, speeding up the breakdown of bone tissue. Results from the Anlene bone health check – a free bone scanning programme that Fonterra carries out here in Singapore, and across Asia – show that 46 percent of Singaporean women, aged 40 and above are at moderate to high risk of developing fractures related to osteoporosis in later life, explains Todd.               

The International Osteoporosis Foundation also projects that more than 50 per cent of the world’s osteoporotic hip fractures will occur in Asia by 2025. This worrying trend can be largely attributed to lifestyle and diet habits, with recent consumer research clearly showing that people are not getting the right nutrition, or enough exercise, to maintain healthy bones.               

If they do not take enough calcium (daily requirement during pregnancy and lactation is about 1000mg), they free up calcium from their own bones thus reducing their bone density and strength. If they are pregnant in their early twenties, they may still be able to replenish these losses as they are in their bone building age group (before 30), explains Dr Chua Yang. However, as women are getting pregnant later in life, any loss sustained in pregnancy may tend to have permanent consequences.


The Best Preventions

Women in their first pregnancy and teenagers who are pregnant are at a higher risk for osteoporosis during pregnancy. It is recommended that women have at least 1,000 mg of calcium each day through increased dietary intake of low-fat dairy products (eg. milk, yogurt, cheese), green leafy vegetables, tofu, almonds, and foods fortified with calcium (eg. orange juice, cereals, and breads), explains Dr Tony Tan, specialist in obstetrics & gynaecology and consultant, Raffles Women’s Centre. Calcium supplements are often prescribed by doctors as well during pregnancy. Regular weight-bearing exercises (eg. walking, climbing stairs, weight training), and quitting smoking and reducing drinking alcohol may also help to further build bone mass.                  

High risk factors for osteoporosis include family history (maternal history particularly important), lifelong lack of exercise, as well as medical conditions that require steroid treatment. While, genetic and medical history may be difficult to alter, remember that lifestyle choices can be actively worked on.


The Deal with Osteoporosis

Testosterone in men is a bone building hormone. This hormone is present in men for most of their lifetime and only gradually dwindle in old age.               

Similarly for women, Oestrogen is also bone preserving. Unfortunately, as early as the years leading up to menopause, women already start to lose this hormone. Women are especially prone to osteoporosis after menopause as the loss of oestrogen production after menopause is the cause of accelerated bone mass loss, explains Dr Tan.               

In addition to the hormonal factor, explains Dr Chua Yang, women go through pregnancies. However, pregnancy fortunately appears to help protect most women’s calcium reserves and it is rare for women to develop osteoporosis during pregnancy or breastfeeding. Women who do experience bone loss during pregnancy or breastfeeding often recover lost bone after childbirth or after they stop breastfeeding.


Pregnancy and Osteoporosis

So if you’re wondering if pregnant women are at a higher risk of getting osteoporosis, Dr Tan says that it is rare and only a small number of pregnant women are especially prone to it. Most women do not suffer from bone loss during pregnancy or breastfeeding. If they do, this is usually transient.               

While it may be rare, it does happen. As a baby needs calcium to grow strong bones, he absorbs what is needed from his mother and what she eats. In some women, their bones may be slightly weakened if they do not get enough calcium during pregnancy, explains Dr Ida Ismail-Pratt, associate consultant, NUH Women’s Centre. It is thus important that you get the recommended daily amount of calcium during your pregnancy.               

Bone density can also be lost during breastfeeding, but this is usually temporary. Most women will recover their full bone density once baby starts weaning, clarifies Dr Ida.              

And there’s even more good news. There have been studies that suggest that pregnancy may be good for bone health overall. In fact, the more times a woman has been pregnant, the lower the risk of her having a fracture in general, explains Dr Tan.    


Your Calcium Intake

The tolerable upper intake of calcium is 2,500mg in age 19 to 50. Women should take 1000mg per day. The recommended daily requirements are less in a child and higher in older women, advises,       Dr Yong Tze Tein, senior consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital. It is 1,300 mg/day from age nine to 18 and 1000 mg at age 18 to 50, 1200mg above age 50.

So should pregnant women take more? According to Dr Yong, that may not be necessary. During pregnancy or lactation, the recommended intake for calcium does not change, with the exception of those younger than 20 who may require up to 1300mg/day as their own bones are still developing.


What about Medication?

Most medications do not cause bone loss if taken for a short period of time. But, Dr Ida explains that long term use of certain medications can increase your risk of bone loss. Some medications that may cause bone loss with long term use include:

·         Steroids that are used to treat many conditions such as asthma, arthritis and lupus

·         Gonadotrophin releasing hormones which are medicines that are used to treat endometriosis

·         Heparin injection for treatment of blood clots in the lung or legs

·         Some anti-seizures medications

·         Aluminum containing antacids because the aluminum blocks calcium absorption


To find out more about other risks and factors contributing to bone loss, it’s always best to consult a medical professional for advice.

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