A case of pregnancy and lactation associated osteoporosis in the third pregnancy; robust response to teriparatide despite delayed administration

Cerit, Ethem Turgay; Cerit, Mahi Nur

doi:10.1016/j.bonr.2020.100706

Cited by 16 publications

(20 citation statements)

References 26 publications

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“…Teriparatide is an osteoanabolic agent and does not accumulate in the bone. Many reports of the BMD increase effect of teriparatide for the treatment of PLO were publicized [ 8 , 9 , 10 , 11 , 12 , 23 , 29 , 30 , 31 ]. Teriparatide effectively improved the lumbar BMD values of PLO patients by almost 20% at 12 months [ 11 , 29 ] and by 19–36% at 18 months [ 10 , 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many reports of the BMD increase effect of teriparatide for the treatment of PLO were publicized [ 8 , 9 , 10 , 11 , 12 , 23 , 29 , 30 , 31 ]. Teriparatide effectively improved the lumbar BMD values of PLO patients by almost 20% at 12 months [ 11 , 29 ] and by 19–36% at 18 months [ 10 , 30 , 31 ]. The half-life of teriparatide is 1 h, much shorter than the half-lives of bisphosphonates and denosumab.…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy and Lactation-Associated Osteoporosis Successfully Treated with Romosozumab: A Case Report

et al. 2022

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Pregnancy- and lactation-associated osteoporosis (PLO) is a rare type of premenopausal osteoporosis that occurs mainly in the third trimester or immediately after delivery; one of its most common symptoms is back pain caused by a vertebral fracture. The pathogenesis of PLO is unclear, and there is no accepted consensus regarding the treatment of PLO. Although treatments with drugs such as bisphosphonate, strontium ranelate, denosumab, and teriparatide were reported, there is no report of a patient with PLO treated with romosozumab. We present the first case of a patient with PLO treated with romosozumab following 4-month teriparatide treatment. A 34-year-old primiparous and breastfeeding Japanese woman experienced severe low back pain 1 month postdelivery. She was diagnosed with PLO on the basis of low bone marrow density (BMD) and multiple vertebral fractures with no identified cause of secondary osteoporosis. She was treated with teriparatide injection for 4 months, but the treatment was discontinued because of the patient feeling severe nausea after every teriparatide injection and the appearance of new vertebral fractures. Thereafter, we used romosozumab for 12 months. After the romosozumab treatment, her BMD was increased from the baseline by 23.6% at L1–L4, 6.2% at the femoral neck, and 11.2% at the total hip. Treating PLO with 12-month romosozumab after 4 months of teriparatide injection remarkably increased the BMD of the lumbar spine, femoral neck, and total hip without subsequent fracture. Romosozumab has potential as a therapeutic option to improve the BMD and reduce the subsequent fracture risk of patients with PLO.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pregnancy and Lactation-Associated Osteoporosis Successfully Treated with Romosozumab: A Case Report

et al. 2022

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“…Unfortunately, as bisphosphonates persist for a long time in bone, are able to cross the placental barrier, and may accumulate in the foetal skeleton, their use is controversially discussed 23 . In contrast to bisphosphonates, teriparatide has a low half-life of only a few hours; it does not accumulate inside the bone matrix and thus poses no threat to subsequent pregnancies if administration is discontinued early enough 12 , 28 . The data of Cohen et al 29 showing low bone remodelling rates at the tissue level in women with PLO provides the pathophysiological rationale for the use of teriparatide in the setting of PLO.…”

Section: Discussionmentioning

confidence: 99%

“…The indistinct clinical symptoms present in pregnancy often considered to be benign antenatal discomfort, the high incidence of musculoskeletal complaints, and the hesitation to perform diagnostic imaging during pregnancy often severely delay the detection of PLO. Therefore, PLO remains underreported and undertreated 11 , 12 . If undetected and untreated, PLO can lead to an accumulation of vertebral compression fractures and subsequent fractures 13 .…”

Section: Introductionmentioning

confidence: 99%

Effect of Teriparatide on Subsequent Fracture and Bone Mineral Density in 47 Women with Pregnancy- and Lactation-associated Osteoporosis and Vertebral Fractures

Hadji

Mouzakiti

Kyvernitakis

2022

Geburtshilfe Frauenheilkd

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Introduction Pregnancy- and lactation-associated osteoporosis (PLO) with predominantly vertebral fractures is a rare but severe disease which can occur in the last trimester of pregnancy or postpartum. The aim of the present study was to assess the impact of teriparatide on subsequent fractures and bone mineral density (BMD) in patients with PLO. Materials and Methods A total of 47 patients with PLO and postpartum spinal fractures (mean: 4 fractures) undergoing treatment with teriparatide were investigated. The data collection period was set between 2006 and 2018. All patients received a subcutaneous injection of 20 µg teriparatide once a day for 24 months as well as individually adapted vitamin D supplementation. After 24 months of treatment, all women received no further treatment and either had regular menstrual cycles or took oral contraceptives. Fractures were confirmed by X-ray or MRI. Changes in BMD from baseline were examined using serial DXA measurements. Results After 24 months of teriparatide treatment, we could demonstrate an increase in BMD at the lumbar spine, femoral neck and total hip of + 30.1%, + 11.7% and + 12.2% respectively (p < 0.001 for all). At 12 months after cessation of treatment, BMD remained stable compared to the 24-month measurements at the lumbar spine, femoral neck and total hip which showed non-significant changes of + 1.4%, + 2.6% and + 4.1% respectively. Out of the 47 patients with PLO with a mean of 4 existing fractures, 4 patients (7.8%) sustained a subsequent fracture, two after 3 – 5 months of treatment and two at > 6 months of treatment. Conclusion 24 months of treatment with teriparatide in women with PLO and multiple vertebral fractures significantly increased BMD, predominantly BMD of the spine. As patients were premenopausal, there was no significant decrease in BMD in the following 12 months after cessation of treatment.

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“…Podávanie bisfosfonátov (v priemere počas 24 mesiacov) alebo teriparatidu (počas 18 mesiacov) bolo u týchto žien asociované so zvýšením BMD, ale nie s redukciou počtu fraktúr (38,58,59). Navyše uvedené štúdie sú realizované na veľmi malej vzorke žien (9, resp.…”

Section: Osteoporóza Asociovaná S Tehotenstvom a Laktáciouunclassified

Osteoporosis in premenopausal women

Payer¹,

Smaha²,

Kužma³

et al. 2021

Vnitr Lek

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U mladých, premenopauzálnych žien v súčasnosti neexistujú jednoznačné odporúčania diagnostiky a liečby osteoporózy. Nízka hodnota kostnej hustoty u premenopauzálnych žien nie je asociovaná s rovnakým rizikom fraktúry ako u postme nopauzálnych žien, preto u nich nie je možné v diagnostickom procese využiť iba denzitometrické vyšetrenie. Väčšina prípadov premenopauzálnej osteoporózy je spôsobená chronickými ochoreniami, ktoré zasahujú do kostného metabo lizmu. Liečba základného ochorenia často vedie k zlepšeniu nielen denzity, ale aj kvality kosti. Zriedkavo je nutné využiť špecifickú antiporotickú liečbu, avšak v súčasnosti nemáme dostatok dôkazov o efektivite a rizikách takejto liečby. Cieľom tohto článku je priniesť súčasný pohľad na definíciu, diagnostiku a liečbu premenopauzálnej osteoporózy.

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A case of pregnancy and lactation associated osteoporosis in the third pregnancy; robust response to teriparatide despite delayed administration

Cited by 16 publications

References 26 publications

Pregnancy and Lactation-Associated Osteoporosis Successfully Treated with Romosozumab: A Case Report

Pregnancy and Lactation-Associated Osteoporosis Successfully Treated with Romosozumab: A Case Report

Effect of Teriparatide on Subsequent Fracture and Bone Mineral Density in 47 Women with Pregnancy- and Lactation-associated Osteoporosis and Vertebral Fractures

Osteoporosis in premenopausal women

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