Special Populations in Osteoporosis

Howdy, Bestie! Okay, I’m not from the South and that felt a little cringe. Let’s try again: Hi, Bestie, and welcome back. I’m happy you’re here. Last week, we talked about the basics of osteoporosis. If you missed that, catch up here. Today, I thought we could stick with the current theme of osteoporosis, but dive a little deeper. There’s a lot more to chat about, so let’s get into some of the special populations in osteoporosis.

We know that osteoporosis is a condition of the bone in which bones are less dense than they should be. This causes brittle bones that are more likely to fracture. This can be especially dangerous in folks that are prone to falling. Osteoporosis occurs most often in post-menopausal females, but there are a few other groups that should be considered in discussions about osteoporosis. These groups are pregnant folks, female athletes, and transgender people.

Pregnancy-Associated Osteoporosis (PAO):

PAO, also called pregnancy-related osteoporosis, is the condition of low bone mass during or shortly after pregnancy. During pregnancy, calcium stored in the mother’s bones may be used for the fetus. This results in lower bone density at the lumbar (lower) spine and sometimes in the bones of the hip. Calcium for breastfeeding has been shown to come from calcium deposits within the mother’s bones (1). This has been a cause for worry, given that some moms choose to breastfeed their babies for long periods of time. Researchers wanted to find out whether a longer period of breastfeeding would negatively impact the bone health of the mother. Several studies have assessed PAO and have found it to be transient. This means pregnancy-related osteoporosis comes and goes on its own, and is temporary. It has also been shown to resolve independently of length of time spent breastfeeding (2). PAO is a rare condition and resolves itself within 19 months of delivery (2).

The bone loss incurred during pregnancy and/or lactation is reversible, which is notably different than bone loss occurring in typical osteoporosis. As we discussed last time, osteoporosis causes irreversible bone loss. PAO can be managed with the help of your healthcare provider and should not cause you to terminate breastfeeding sooner than you want.  

Female Athlete Triad (FAT):

FAT, more accurately known as Relative Energy Deficiency in Sports (RED-S) is another condition with links to osteoporosis. This condition often occurs in young, female athletes, but can present itself in people of all genders. The female athlete triad is characterized by disordered eating, amenorrhea, and osteoporosis/osteopenia. Disordered eating is not the same as an eating disorder and can present as restrictive eating, compulsive eating, and/or various other forms. Amenorrhea is the absence of a menstrual period during the reproductive years.

Estrogen helps to block the activity of osteoclasts, or the cells that work to break bone down. When estrogen is reduced, osteoclasts work faster and this causes more bone to be resorbed. In people experiencing amenorrhea, estrogen is reduced and this contributes to poor bone density in young athletes experiencing a loss of menstrual period.  

The reason FAT is now more commonly called RED-S is because it describes a high level of activity with not enough nourishment to sustain. Someone with RED-S can experience low energy levels, an erratic heartbeat, poor bone health, increased risk for injury, and reduced athletic performance. RED-S can have lifelong consequences as the bone mineral density (BMD) lost due to the condition cannot be recovered (3). The adolescent period is one of the most important times in life for our bones to become strong and build up calcium stores, so having low bone mass/density during this period is particularly detrimental.

Osteoporosis in the Transgender Population:

The last group of people I wanted to touch on is the transgender population. One of the first lines of treatment for transgender folks experiencing gender dysphoria and going through transition is hormone therapy. Transgender men undergoing hormone therapy usually take testosterone in order to heighten characteristics typically considered to be masculine (i.e. facial hair). Transgender women going through hormone therapy often take estrogen, along with testosterone blockers and progesterone.

Due to the introduction of different hormones to the body, there has been a great deal of speculation about what this means for bone health among this population. However, most studies have shown that hormone therapy does not have a negative effect on bone health. The addition of testosterone in transgender men seems to have little to no effect on bone health, and the addition of estrogen has been shown to improve bone health in transgender women (4). Even though many studies have confirmed these same results, more research will need to be done with focus on long-term effects on hormone therapy in the transgender population (5). Though this population has been the subject of a lot of theorizing in regard to osteoporosis, the condition does not seem to be more common among transgender folks of either gender.

Okay, that’s it for now, y’all! Wow, still not Southern, still not workin’. Let’s chat soon.

XOXO,

Your Pelvic Bestie

References:

1.     Glerean M, Furci A, Galich AM, Fama B, Plantalech L. Bone and mineral metabolism in primiparous women and its relationship with breastfeeding: a longitudinal study. Medicina (B Aires). 2010;70(3):227-32.

2.     Møller UK, Við Streym S, Mosekilde L, Rejnmark L. Changes in bone mineral density and body composition during pregnancy and postpartum. A controlled cohort study. Osteoporos Int. 2012 Apr;23(4):1213-23.

3.     Warren MP, Perlroth NE. The effects of intense exercise on the female reproductive system. J Endocrinol. 2001 Jul;170(1):3-11.

4.     Rothman MS, Iwamoto SJ. Bone Health in the Transgender Population. Clin Rev Bone Miner Metab. 2019 Jun;17(2):77-85.

5.     Stevenson MO, Tangpricha V. Osteoporosis and Bone Health in Transgender Persons. Endocrinol Metab Clin North Am. 2019 Jun;48(2):421-427.

*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.