09 September is PAO Awareness Day
09 September 2026 marks the first Worldwide PAO Awareness Day
Pregnancy Associated Osteoporosis: why awareness matters
ADVOCACYPOLICYPAO STORIES
9/9/20265 min read
Pregnancy Associated Osteoporosis (PAO) is a rare and poorly recognised form of osteoporosis that can have a profound effect on women and their families.
For some women, the first sign is sudden, severe pain during late pregnancy or in the months after giving birth. That pain may be caused by fractures in the spine or other bones.
Yet women with PAO can spend weeks, months or even years being told that their pain is a normal part of pregnancy, childbirth, breastfeeding or caring for a baby. Some are diagnosed only after repeated appointments, worsening symptoms or further fractures.
Awareness matters because earlier recognition could mean earlier investigation, diagnosis, treatment and support.
A worldwide awareness day
Pregnancy Associated Osteoporosis Awareness Day is being launched virtually around the world, as well as in person at the UK's leading Osteoporosis Conference on 09 September 2026.
PAO UK trustees will be attending the event, with PAO UK specialists delivering keynote presentations. There will also be a large PAO display, with live reports throughout the event.
The date of 9 September reflects the nine months of pregnancy and the nine months of maternity – the periods surrounding pregnancy and birth when Pregnancy Associated Osteoporosis can develop.
Women's stories need to be heard
The experiences of women living with PAO provide an important insight into the condition and its impact.
Beth's story
Beth developed severe back pain around eight weeks after the birth of her second son. She had experienced almost identical pain after the birth of her first son but it had not been investigated.
After the birth of her second son, she saw her GP several times and was referred to a physiotherapist. She was also seen at A&E, where she was told she had sciatica.
By this point, Beth was struggling to walk, sleep and care for her baby. Eventually, an MRI revealed osteoporosis in her spine and eight spinal fractures. The radiologist identified the fractures as being indicative of Pregnancy Associated Osteoporosis.
“I feel there needs to be more awareness of this horrible condition as it seems many doctors don't take women with severe back pain seriously,” Beth says.
The physical effects had a significant impact on Beth's mental health, family life and finances. Six months after the fractures, she was beginning to do more but was still unable to lift her baby and needed to rest frequently.
Jane's story
Jane's experience also highlights how difficult PAO can be to recognise.
After the birth of her first baby, she developed severe back pain and spasms and was repeatedly told that the problem was related to her posture while breastfeeding. She lost three inches in height over several months.
After her second pregnancy, the same agonising pain returned. By then she had lost five inches in height. Eventually, an X-ray showed several spinal fractures and an MRI confirmed fractures in ten vertebrae. A DEXA scan showed severe osteoporosis, with a spine score of -4.1.
Jane was eventually diagnosed with Pregnancy Associated Osteoporosis at the age of 41. “Although this rare disease has impacted my whole life, and my children’s lives, it has also shown me how mentally strong and resilient I am,” she explains.
A story that began 35 years ago
Karen's story
Karen has lived with PAO for 35 years.
Her experience began in 1991, when she developed sudden, severe back pain during the final weeks of pregnancy. Her symptoms were initially dismissed as normal pregnancy pain. She went into labour without feeling contractions and experienced her back giving way during labour.
After giving birth, Karen was unable to pick up her baby and struggled to move because of the pain. Her husband repeatedly raised concerns about how much shorter she appeared but these concerns were also dismissed.
Eventually, an X-ray showed that her back was broken in four places. A subsequent DEXA scan confirmed severe osteoporosis.
“My PAO impact could have been so much less if I had been quickly diagnosed and able to immediately access anabolic treatment and specialist care,” she says.
Her story demonstrates how far-reaching the consequences of PAO can be. Over many years, the condition affected her physical and mental health, family life, finances and career. She experienced numerous further fractures before receiving effective anabolic treatment.
Importantly, Karen's experience also shows that things can change. Since starting anabolic treatment more than 12 years ago, she has not had a single fracture and her bone density has improved.
Yet her experience also highlights the need for continued progress. More than three decades after her diagnosis, Karen is understandably frustrated that women in the UK are still experiencing delays in diagnosis and difficulties accessing appropriate care and treatment.
A recent step forward
There has been an important development in the UK this year.
In 2026, Pregnancy Associated Osteoporosis was recognised for the first time in an updated osteoporosis guideline from the National Institute for Health and Care Excellence (NICE).
PAO UK was an "Expert Stakeholder Organisation" and contributed to the development of the guideline, with input from its trustees and medical and scientific committee.
For a rare condition that has historically been unfamiliar to many healthcare professionals, this is an important step towards greater recognition.
It does not however, resolve all the challenges faced by women with PAO. There is still a need for greater awareness, earlier diagnosis, appropriate treatment and more research into the condition.
But formal recognition in national guidance is progress.
Recognising the signs
PAO is rare, and severe back pain during pregnancy or after giving birth will usually have another explanation. However, severe or sudden pain should not automatically be dismissed as a normal part of pregnancy or the postnatal period.
Women with PAO may experience:
Sudden or severe back or hip pain
Difficulty walking or moving normally
Difficulty lifting or caring for their baby because of pain
Sudden muscle spasms
Noticeable loss of height
Unexplained fractures.
These symptoms do not mean that someone has PAO. But awareness that the condition exists may help ensure that it is considered when the symptoms and circumstances are appropriate.
Hear from women living with PAO
This year's Worldwide PAO Awareness Day brings together stories from women at different stages of their PAO journeys, through both videos and articles. Their experiences are different but together they show why greater awareness is needed.
Introduction to PAO Awareness Day
Watch Caroline tell us about PAO Awareness Day
Shelley
Watch Shelley's story
Rosie
Watch Rosie's story
Hannah
Watch Hannah's story
Caroline
Read Caroline's story
Tessa
Read Tessa's story
Beth
Watch Beth's video
Read Beth's full story
Karen
Watch Karen's video
Read Karen's full story.
Why awareness matters
A diagnosis cannot undo the fractures or give women back the time they've lost. But earlier recognition can help women access appropriate investigation, treatment and support sooner.
Awareness is important not only for women and their families, but also for GPs, midwives, physiotherapists, hospital clinicians, researchers and other healthcare professionals who may encounter PAO.
The first Worldwide Pregnancy Associated Osteoporosis Awareness Day is an opportunity to make this rare condition better known and to ensure that women's experiences are heard.
Know the signs. Change the story.
