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. 2019 May 13;9:6787. doi: 10.1038/s41598-019-43049-1

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Schematic showing mechanisms underlying bone fragility or low-energy fractures due to pregnancy and lactation. Fragility or low-energy fractures can occur in the maternal skeleton during pregnancy and lactation via mechanisms shown. Fetal calcium is supplied from the maternal skeleton, promoting high bone turnover due to a drastic drop in estrogen levels after partum. These outcomes promote osteoclast activity without accompanying osteoblast activity and a loss in bone mass in breastfeeding-only conditions. Note that low bone mass may exist before pregnancy, and a combination of bone metabolic changes and mechanical stresses may also play a role in fragility or low-trauma fractures.