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Research Article
Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, P.O Box
21589, Saudi Arabia
80215, Jeddah
The aim was to see the effect of pregnancy on Bone Mineral Density (BMD) and bone turnover
markers (BTMs) in the immediate postpartum period and 12 months thereafter. Eighty women
delivered at KAUH (May 2009-Oct 2010) had BMD, bone profile, 25-OH vitamin D and (BTMs).
Inclusion criteria: Singleton pregnancy without medical or pregnancy complications. Exclusion
criteria: multiple pregnancies, history of diabetes thyroid or bone disease, and use of any
medication that affect calcium metabolism.
Biochemical tests were repeated for 27 women after one year. Statistical analysis was done using
SPSS 16. Eighty women had BMD before discharge. Sixty four women (80%) had low BMD; sixteen
of these (25%) had osteoporosis. Although bone profiles were normal, Vitamin D levels were
moderately or severely deficient in 35.37% of women. After adjustment for BMI and age there was
no correlation between BMD and other variables. Multiple linear regressions showed that BMI was
the predictor for BMD (P=0.0014). There was no significant difference between postpartum bone
BTMs and bone profiles, and those after twelve months.
Osteoporosis/ osteopenia is a significant health problem in this group of women. Further studies
are needed to look into predisposing factors.
Key words: Osteoporosis, osteopenia, postpartum, Bone Mineral Density (BMD), Bone Turnover Markers (BTM), 25
OH vitamin D
INTRODUCTION
Osteoporosis is a major health problem affecting a large
sector of population leading to devastating disabilities
including inability to walk and requiring long term care
and that can also be a burden on costs of health care
(Riggs and Melton, 1995; Consensus Conference From
the National Institutes of Health, 2001; Cooper et al.,
1993)
Sadat-Ali M et al., (2004) reported a prevalence of
osteoporosis
(46.7%)
in
a
group
of
Saudi
postmenopausal women. Similarly, Ghannam et al.,
(1999) estimated the prevalence of osteopenia and
019
Demographic characteristics
Age
Gravida
Para:
0-1
2-4
>/5
Weight kg
Height m
BMI
Antenatal visits
Birth weight gm
Mean
28.2
3.7
Standard deviation/SEM
6.3/0.73
2.7/0.29
41 (45.6%)
33 (36.7%)
15 (16.7%)
1: missing data
69.69
1.54
28.3
2.5
3000
1.6/1.7
1.76/1.88
5.18/0.56
1.87/0.198
0.52/0.27
Table 2. The mean of postpartum serum bone profile, serum turnover markers and BMD
Test
Serum Calcium
Serum Phosphate
Alkaline phosphate
25 OH vitamin D
Osteocalcin
CTx
BMD spine
Tscore spine
Zscore spine
BMD left femur
BMD right femur
Mean
2.48
1.105
172.69
35.35
11.01
2.93
0.88
1.54
1.46
0.802
0.78
Standard Deviation
0.08
0.172
5.9
1.98
7.24
3.16
0.099
0.85
0.83
0.095
0.155
NB:
Serum calcium: Normal range (2.12-2.52 mmol/l)
Serum phosphate (PO4): Normal range (0.8-1.58 mmol/l)
Alkaline phosphatase: Normal range ( 50-136 U/l )
25 hydroxy vitamin D: Normal range (75-200 nmol/l)
Serum osteocalcin: Normal range ( 4-15 ng/ml)
Serum CTx: Normal range (0.1-1.27 ng/ml)
RESULTS
Ninety women, who delivered spontaneously and have
no antenatal complications, were recruited for the study.
Ten of these women were discharged before BMD
studies were done.
The demographic data of these women were shown in
Table 1. More than 50% of the study group were
multigravidas (54.4%).Three women were black, two
were Asians, and only one was Mediterranean and the
rest were Saudi citizens ( not included in the table). The
mean BMI of the study group was 28.3%. Of the women
studied, 53 % had adequate dietary calcium intake but
only three (3.33%) continued regular calcium
supplements throughout pregnancy.
All postpartum values of the bone profile of these women
were within normal range. The mean of postpartum
serum 25 OH vitamin D was 35.35 nmol /l (Normal 75-
Table 3. Correlation between BMD and other independent variables after adjusting for ageand BMI.
Variable
Number of pregnancies
Parity
Lactation (month )
CTX PP
Osteocalcin pp
25-OH Vitamin D3
r
0.26
0.72
-0.88
0.13
-0.56
-0.44
P value
0.7
0.3
0.1
0.9
0.4
0.6
Table 4. Correlation between BMD and other variables after adjusting for age and BMI.
Control Variables
age & BMI
Correlation
Sign (2-tailed)
Correlation
Sign (2-tailed)
Correlation
Sign (2-tailed)
Correlation
Sign (2-tailed)
Correlation
Sig (2-tailed)
Correlation
Sign (2-tailed)
Correlation
Sign (2-tailed)
P
Lactation
month
BMD
CTXPP
Osteopp
vitD
G
1.000
.
.686
.314
-.255
.745
.256
.744
.439
.561
.588
.412
-.786
.214
P
.686
.314
1.000
.
-.868
.132
.724
.276
-.101
.899
-.168
.832
-.938
.062
Lactation
month
-.255
.745
-.868
.132
1.000
.
-.883
.117
.298
.702
.630
.370
.676
.324
BMD
.256
.744
.724
.276
-.883
.117
1.000
.
.125
.875
-.558
.442
-.442
.558
CTX-PP
.439
.561
-.101
.899
.298
.702
.125
.875
1.000
.
.555
.445
.161
.839
Osteo-pp
.588
.412
-.168
.832
.630
.370
-.558
.442
.555
.445
1.000
.
-.088
.912
vitD
-.786
.214
-.938
.062
.676
.324
-.442
.558
.161
.839
-.088
.912
1.000
.
Table 5. Multiple linear regressions showed that BMI was a significant predictor for BMD. Variables in the model included parity, gravidity,
BMI, Age, & vitamin D.
Coefficientsa
Model
(Constant)
BMI
Unstandardized Coefficients
B
Std. Error
.627
.071
.009
.002
Standardized
Coefficients
Beta
.451
t
8.886
3.610
Sig.
.000
.001
021
Table 6. Paired t-test comparing postpartum levels of osteocalcin & CTx to their levels after one year
Paired Samples Statistics
Pair 1
Osteocalcin (pp)
Osteocalcin (12m)
Mean
11.0109
12.9783
Std. Deviation
7.24002
8.09034
St d. Error Mean
1.50965
1.68695
Paired Differences
95% Confidence Interval of
Std.
Error the Difference
Mean
Std. Deviation Mean
Lower
Upper
t
Pair 1 Ost pp - Ost.12m -1.96741 7.98775
1.66556
-5.42157
1.48675
-1.181
df
22
Sig. (2-tailed)
.250
df
Sig. (2-tailed)
21
.065
Table 7. Paired t-test comparing postpartum levels of CTx to their levels after one year
Mean
Std. Deviation
Std.Error Mean
Pair 1
CTXPP
2.9268
3.16390
.67455
CTx12m
5.5364
6.21040
1.32406
Paired Samples Test
Paired Differences
Pair 1 CTXPP
CTx12m
Mean
Std.
Deviation
Std.
Mean
-2.60955
6.29752
1.34264
.18262
-1.944
DISCUSSION
It is noticed from this study that the prevalence of Low
Bone Density (osteopenia/ osteoporosis) is high in this
group of Saudi women (71.11%). This finding was
immediately postpartum which denotes that the loss
occurred prior to delivery: either during pregnancy or
before pregnancy. A BMD study before pregnancy would
have helped to differentiate between these two.
A high prevalence of osteoporosis in postmenopausal
women was reported (Sadat-Ali et al., 2004) to be 46.7%,
the rate in this study was even higher in these
postpartum women.
This finding (this color 24062014) may suggest indirectly
that a low BMD during the womens reproductive years
Mansouri et al.
022
CONCLUSION
Low
Bone Density, including Osteoporosis is a
significant health problem in this group of women. More
studies are needed to look into factors that increases the
risk in this young group of patients .Could that be related
to poor attainment of PBM or early pregnancy in
adolescent age or to high parity or the known factors in
this population including poor dietary calcium, lack of sun
exposure or lack of exercise. Further studies are needed
to look into these factors.
Conflict of Interest Statement
We declare that we have no conflict of interest.
ACKNOWLEDGEMENT
This project had been funded by deanship of Scientific
Research (DSR) / King Abdul-Aziz University, under
grant number (5/007/429). Therefore we acknowledge
with thanks DSR support for scientific research. Special
thanks are to Miss Manal Baklo to her help in obtaining
data.
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Copyright: 2015 Mansouri et al. This is an openaccess article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium,
provided the original author and source are cited.
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