Bone Microarchitecture and Strength Changes During Teriparatide and Zoledronic Acid Treatment in a Patient with Pregnancy and Lactation-Associated Osteoporosis with Multiple Vertebral Fractures

Abstract

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis, of which the pathogenesis and best treatment options are unclear. In this report, we describe the case of a 34-year old woman diagnosed with severe osteoporosis and multiple vertebral fractures after her first pregnancy, who was subsequently treated with teriparatide (TPTD) and zoledronic acid (ZA). We describe the clinical features, imaging examination, and genetic analysis. Substantial improvements were observed in areal and volumetric bone mineral density (BMD), microarchitecture, and strength between 7 and 40 months postpartum as assessed by dual-energy X-ray absorptiometry at the total hip and spine and by high-resolution peripheral quantitative CT at the distal radius and tibiae. At the hip, spine, and distal radius, these improvements were mainly enabled by treatment with TPTD and ZA, while at the distal tibiae, physiological recovery and postpartum physiotherapy due to leg pain after stumbling may have played a major role. Additionally, the findings show that, despite the improvements, BMD, microarchitecture, and strength remained severely impaired in comparison with healthy age- and gender-matched controls at 40 months postpartum. Genetic analysis showed no monogenic cause for osteoporosis, and it is suggested that PLO in this woman could have a polygenic origin with possible susceptibility based on familiar occurrence of osteoporosis.

Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis

“…Overall, in addition to 24 new (single) case reports [23,44,51,[55][56][57][58][59][60][61][62][63][64][65][66][67][68], we identified 12 original studies (with at least 6 patients with PAO/LAO per study): 1 study was published in 2023 (within the first 3 months of the year), 5 were published in 2022, and 6 in 2021. Except for one survey [43], these were retrospective cohorts (one being a nationwide study in Japan) [41].…”

“…A 34-year-old female was treated with TPT followed by ZOL (in a recent case published in 2023) with a good outcome registered by central DXA and high-resolution peripheral quantitative CT scans, but reported values remained lower than similar controls at 40 months after delivery. Genetic tests (considering the traditional panel for monogenic osteoporosis) were negative, thus being suggestive of a polygenic involvement in the pathogenic loop of osteoporosis [58].…”

Pregnancy and lactation‐related osteoporosis in a 22‐year‐old‐woman

“…Pregnancy and lactation‐associated osteoporosis (PLO) is an uncommon condition of skeletal fragility that affects women during pregnancy or postpartum period. It presents with back pain and vertebral compression fractures 2 . The management of PLO is challenging, but early diagnosis, stopping breastfeeding, treatment of anti‐osteoporosis medicine, and regular follow‐ups are necessary for the prevention of fractures and to increase the mother's quality of life 3,4 .…”

“…It presents with back pain and vertebral compression fractures. 2 The management of PLO is challenging, but early diagnosis, stopping breastfeeding, treatment of anti‐osteoporosis medicine, and regular follow‐ups are necessary for the prevention of fractures and to increase the mother's quality of life. 3 , 4 We present a very rare case of a 22‐year‐old woman, who has been diagnosed with PLO 5 months after delivering her child.…”

Clinical significance of zoledronic acid in combination with calcium tablets and calcitriol for hip biomechanics and bone mineral density after total hip replacement: a prospective randomized controlled trial

“…It has a high a nity for mineralized bone and can selectively act on bone to inhibit osteoclast activity and induce osteoclast apoptosis, thereby inhibiting bone resorption and improving bone density, thereby reducing revision rate and prolonging the service life of prosthetics. Reduces the risk of recurrent fractures [3][4][5][6]. It has been reported that a single injection of ZA can effectively improve bone mineral density (BMD) for at least 12 months [7] and has a positive effect on male BMD [8].…”