Written in bone: pregnancy, fracture and transition

We were discharged at 5pm the next day and I visited the GP just days later. He referred me to the physio who thought I seemed okay. About three months later I felt a pop in my back when lowering Maeve into her cot. I tried to stretch out the discomfort but then experienced a sharp stabbing pain and my back muscles went into spasm.

I increasingly lacked energy, often watching the day pass from the sofa while Maeve slept on me. Lifting an ever heavier Maeve became a daily challenge. After a few more fruitless visits to the GP, I used my work health insurance to insist on a scan of my back. The results showed I had a compression fracture in my spine.

After not being listened to on many occasions, the diagnosis validated my experience since having Maeve, as well as the lack of dignity I’d felt in hospital.

It’s unusual for someone in their mid-thirties to fracture their spine, so I was sent for a bone density scan. It showed severe bone loss for my age. In July 2022, eight months after giving birth at age 36, I was officially diagnosed with Pregnancy Associated Osteoporosis.

It’s not known what causes PAO. It’s likely a mix of factors for different women, with pregnancy and breastfeeding acting as the trigger. Potential risk factors include low body weight, certain autoimmune conditions, vitamin D deficiency, eating disorders, chronic stress, hypermobility, and some anti-blood clotting medications when used over a prolonged period.

Because most women diagnosed with PAO seem otherwise healthy beforehand, the diagnosis comes as a profound shock.

Before this happened, I’d assumed my bones were solid and dependable. I didn’t think of them as vulnerable. It hadn’t occurred to me that they respond to hormones, diet, stress and the way I move through my days.

Bones hold many aspects of our lives, from inherited genes to illness and patterns of living, and, over time, these actually become written in bone. Learning about bone remodelling altered how I understood the fracture, and it no longer felt like a random event.

When I look back at the years before pregnancy, I can see how easily I dismissed the physical impact of sustained pressure. None of this explains the condition but it does make me reconsider my habits.

Bones respond to how we live, as well as what we carry. They strengthen where they’re repeatedly used and thin where they’re not. From that understanding I’ve tried to rebuild more carefully, by changing my habits and also working to influence systemic healthcare change.

It was through speaking to other mums about PAO for various journalism articles that I realised many of our stories sounded the same. We were often just as impacted by not being believed or properly investigated as we were by the condition itself, and by the difficulties many of us faced in accessing appropriate treatment and care.

The expectations placed on new mothers rarely adjust to account for physical recovery. I found myself trying to meet those expectations while increasingly doubting my own judgement.

Over the past four years, motherhood, illness and grief have all made me reassess how I live, not just for me, but for my daughter. They’ve made me more aware of the importance of daily habits and the places we live when thinking about long-term wellbeing.

One thing I’ve come to realise is that bone density responds gradually to repetition, from nutrition and hormones to movement and rest. I think confidence also returns in a similar way, through trying new things and beginning to trust your body again.

I now take HRT to protect my bones and am more aware of how to support my health, even through big transitions. I’ve also chosen to write about PAO, both to process what happened and what I’ve learned, and in the hope that other women are believed sooner and that bone health is taken seriously.