In this manner, the condition of osteopenia, defined by lower-than-normal bone density, has been increasingly recognized as important within women during their peripartum periods for the last two decades. In fact, it is a crucial time frame that deals with the late stages of pregnancy and goes through the postpartum stage, involving multiple physiological changes that can influence the level of bone metabolism [1]. Due to the enormous needs for calcium and other nutrients to feed the developing fetus, some women develop osteopenia if they do not ensure adequate nutritional or supplemental intake [2].

Osteopenia and osteoporosis are two conditions brought about by the increasing prevalence globally. Studies show that women, more so postmenopausal women, are at a higher risk of suffering from osteoporosis and osteopenia due to changes caused by the loss of hormones that impact bone density [3]. The peripartum period also introduces another dimension in this regard, since hormonal changes, especially alterations in estrogen and progesterone, might affect bone remodeling activities. Although its importance is very high, there is still a shortage of regional data that would include some incidence of peripartum osteopenia in specific populations, especially in developing regions [4].

Southern Odisha is an area with very different demographics and cultural circumstances. The inhabitants have other kinds of eating habits at times, lesser opportunities to seek medical attention for some subgroups, and socio-economic factors which may influence maternal nutrition and general bone health. Women generally have multiple disadvantages-they may not have access to prenatal care and nutritional education-and these might contribute a little more to the risk of getting osteopenia during and after pregnancy [5-6].

Incidence of Peripartum Osteopenia in Southern Odisha: Understanding the Incidence of Peripartum Osteopenia in Southern Odisha is important for several reasons. First, this would alert health care professionals regarding the necessity for focused screening and intervention strategies pertaining to the condition [7]. Knowing the risk factors connected with osteopenia at this period may help in devising community-based education programs to be designed for enhancing the nutritional practices among pregnant and postpartum women. Finally, the findings can be attributed to a wider understanding of maternal health in resource-limited settings to guide policymakers in enhancing maternal and child health services [8].

The present study is undertaken with the intention of reporting on the prevalence of peripartum osteopenia in women of Southern Odisha and describing how dietary practice and nutritional status relate to such women. It is hoped that by casting light on this major health issue, strategies for countering the risks associated with osteopenia during the peripartum period could evolve more effectively [9-10].

Study Design

A cross-sectional study was conducted to assess the prevalence of peripartum osteopenia among women living in Southern Odisha. The study was appropriately authorized by the ethical committee at the institution to ensure ethical considerations and protect the rights of all participants.

Population Studied

The third trimester pregnant women and women in the first six months postpartum, aged 18 to 45 years, attending antenatal and postnatal clinics of selected health facilities in Southern Odisha constituted the study population. Applying appropriate statistical methods for calculating the power and reliability of the study, a sample size of approximately 300 was determined.

Inclusion Criteria

• Women aged 18-45 years.
• Third trimester pregnant women or postpartum women within six months of delivery
• Informed consent from the female participants for the study

Exclusion Criteria

• Women that are on long term medication which has alterations in metabolism of bones like corticosteroids
• Women suffering chronic diseases- like renal or liver diseases or metabolic disorders

Data Collection

Data were obtained through a questionnaire and physical assessments. The questionnaire was structured and administered to get some demographic information, dietary habits, socioeconomic status, and medical history of the respondents. Additionally, the levels of physical activities were assessed using a validated questionnaire for the participants.

Osteopenia Assessment

BMD was measured with DEXA scans, considered as the gold standard for estimation of bone density. Scanning was done at accredited imaging centers across Southern Odisha. To classify osteopenia according to WHO criteria, T-scores between -1.0 to -2.5 standard deviations from the mean for young adults were considered.

Nutritional Assessment

Dietary intakes were assessed using 24-hour dietary recall and food frequency questionnaire. Status of nutrition was gauged using serum levels of calcium and vitamin D, including dietetic calcium intake. Biochemical markers by blood samples were analyzed in accredited laboratories.

Statistical analysis

Data analysis was performed with the help of statistical software like SPSS version 25.0. Descriptive statistics were utilized to compute demographic and clinical characteristics. The prevalence of osteopenia was determined as a percentage from the whole study population. Chi-square tests were applied for categorical variables to determine if there is an association of osteopenia with the variable involved, whereas t-tests or Mann-Whitney U test was carried out based on the type of data. Any p-value of < 0.05 was considered statistically significant.

Study Population
A total of 300 women participated in the study, comprising 150 pregnant women in their third trimester and 150 postpartum women. The demographic characteristics of the participants are summarized in Table 1.

Table 1. Demographic Characteristics of Participants

Incidence of Peripartum Osteopenia
The overall incidence of peripartum osteopenia was found to be 35%, with a notable difference between the two groups. Among the pregnant women, the incidence was 28%, while it increased to 42% in the postpartum group (p = 0.034). The details are presented in Table 2.

Table 2. Incidence of Peripartum Osteopenia

Nutritional Status and Risk Factors
Analysis of dietary intake revealed that only 55% of participants met the recommended dietary allowance (RDA) for calcium, and 45% had insufficient vitamin D levels. The relationship between dietary calcium intake and the incidence of osteopenia is illustrated in Figure 1.

Figure 1. Relationship between Dietary Calcium Intake and Incidence of Osteopenia

Biochemical Markers
Serum calcium and vitamin D levels were significantly lower in women diagnosed with osteopenia compared to those with normal bone density. The findings are summarized in Table 3.

Table 3. Biochemical Markers in Relation to Osteopenia

Physical Activity Levels
Physical activity levels were significantly lower in women with osteopenia compared to those without, with 68% of osteopenic women reporting low physical activity levels. This trend is shown in Figure 2.

Figure 2. Physical Activity Levels Among Participants with Osteopenia

The study revealed a concerning incidence of peripartum osteopenia, particularly among postpartum women. Inadequate dietary calcium and vitamin D, coupled with low physical activity levels, emerged as significant risk factors.

The main aim of the present study was to estimate the prevalence of peripartum osteopenia among women in Southern Odisha, with special emphasis on possible risk factors related to nutrition and levels of physical activity. Overall prevalence was found to be 35%. A higher prevalence of osteopenia was observed in postpartum women (42%) compared to those in the third trimester of pregnancy (28%). These findings thus highlight the vulnerability of women in the peripartum period, especially after delivery, when bone density may be substantially decreased because of physiological changes and lifestyle factors [11].

Osteopenia was found to be prevalent by this study, fitting the increasing body of evidence that pregnancy and lactation adversely affect bone health. Increased calcium requirements, especially in the third trimester, may deplete maternal stores unless dietary intake or supplementation is adequate during pregnancy [12]. Our analysis of dietary intakes further supports this finding, as less than half of our study subjects attained the recommended daily allowances for calcium, and a large proportion of women had deficiency levels of vitamin D. These deficits are significant risk factors for osteopenia, as both calcium and vitamin D are integral to the process of bone mineralization as well as the overall structural integrity of the skeleton [13].

One additional significant risk factor that stood out in our postpartum study was that a number of clinical factors may be contributing to this particular demographic. A second area of additional risk associated with osteopenia is that lactation is associated with increased bone resorption-the mother's calcium stores are leached from the bones for use in the production of her milk. In addition, changes in hormones after delivery, particularly an increase in estrogen level, might negate the bone remodeling process and, therefore, increase the rate at which the bone density goes down. A combination of these physiological factors with insufficient nutrition in the postpartum may explain the higher prevalence of osteopenia among this group of patients [14-15].

Physical activity, as our data seem to suggest, is significantly important in the preservation of the health of the bones. Women with osteopenia reported a lower level of physical activity than those with normal bone density. Exercise, and weight-bearing exercise in particular, is widely recognized as a stimulant to bone formation and strengthening. The predominant finding in our volunteers with osteopenia-that of low levels of physical activity-suggests that lifestyle factors, rather than nutritional inadequacies, contribute to the development of osteopenia in the peripartum period. Promoting physical activity in these women through all the stages, including the postpartum stage, would reduce bone loss to a greater extent [16].

Biochemical determination of serum calcium and vitamin D shows significant deficiency of both of these elements in osteopenic females. Both serum calcium and vitamin D levels in osteopenic females were significantly lower than those of normal-density compared to the control group, suggesting a very close association of biochemical markers with the health of bone. Vitamin D deficiency is an exceedingly common disorder in India, resulting mainly from less exposure to sunlight and dietary uptake, and it further impairs calcium absorption and bone metabolism, thus increasing the risk of osteopenia. Our findings suggest that routine evaluation of vitamin D and calcium levels in pregnant and postpartum women helps identify women at increased risk for osteopenia and thus targets them for supplementation and dietary correction [17-18].

More than the individual health outcome, this study has numerous implications. Peripartum osteopenia has long-term effects on the health of the mother thus uprising the opportunity of developing osteoporosis at later stages. Osteoporosis is one of the major public concerns of health issues among the aged people, and the prevention of the progression of osteoporosis can be possible only through early diagnosis and management of osteopenia. In the context of women and socio-economic difficulties and health issues in Southern Odisha, it is pertinent to initiate community-based educational programs aimed at proper nutrition, exercise, and follow-up supervisory care of bone status [19].

The severity of peripartum osteopenia in Southern Odisha calls for focused strategies for strengthening maternal bone health. The predominant risk factors for osteopenia in the population were nutritional deficiencies, particularly inadequate calcium and vitamin D intake, as well as low levels of physical activity. The healthcare provider should routinely screen patients for bone health and facilitate preventive measures, such as nutrition counseling and promotion of physical activity, to reduce the burden of osteopenia in the peripartum period. Further research will then be required to determine long-term outcomes of osteopenia in this group, and also possibly with a view to developing effective preventive and management strategies [20].

The results highlight high prevalence of peripartum osteopenia among women in Southern Odisha, particularly at the postpartum stage. Strong contributors to lower bone density were estimated to be inadequacy of calcium and vitamin D in nutrition, and poor activity levels. But these findings underscore the need for looking beyond a comprehensive maternal health strategy that comes with bone health screening, nutritional supplements, and exercise for pregnant women and in the postpartum period. Once we have addressed these modifiable risk factors we stand to have good hope of reducing the long-term risk of osteoporosis and ultimately improving maternal health outcomes in this region.

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