Changes in bone mineral density and bone turnover markers during treatment with teriparatide in pregnancy‐ and lactation‐associated osteoporosis

Hong, Namki; Kim, Jo Eun; Lee, Su Jin; Kim, Se Hwa; Rhee, Yumie

doi:10.1111/cen.13557

Cited by 52 publications

(33 citation statements)

References 33 publications

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“…Thus, the very low bone remodeling state in women with PLO may have implications for both our understanding of disease mechanisms, and our expectations for responsiveness to therapeutic agents that stimulate bone formation. In this regard, a relatively large study of teriparatide in 27 women with PLO found that teriparatide responsiveness was quite variable, with spine aBMD changes at 12 months ranging from 4.5% to 34.3% . Thus, some women with PLO may be relatively unresponsive to teriparatide.…”

Section: Discussionmentioning

confidence: 99%

“…(1)(2)(3)(4)(5)(6)(7)(8) This assumption reflects data available from a great many studies of bone density and bone remodeling changes that occur with normal pregnancy, lactation, and weaning in healthy women. As in healthy women, studies of PLO women document large postpartum and postweaning BMD increases (45,48) ; however, it is not known whether PLO women experience the same trajectory of bone density and remodeling recovery as normal women. Thus, it is possible that some PLO women had further BMD increase after the study time point.…”

Section: Journal Of Bone and Mineral Researchmentioning

confidence: 99%

“…In this regard, a relatively large study of teriparatide in 27 women with PLO found that teriparatide responsiveness was quite variable, with spine aBMD changes at 12 months ranging from 4.5% to 34.3%. (48) Thus, some women with PLO may be relatively unresponsive to teriparatide. Future studies will be required to determine whether lack of response to teriparatide is associated with low baseline bone formation rate at the tissue level.…”

Section: Journal Of Bone and Mineral Researchmentioning

confidence: 99%

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Women With Pregnancy and Lactation–Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level

Cohen

Kamanda‐Kosseh

Dempster

et al. 2019

Journal of Bone and Mineral Research

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Pregnancy and lactation–associated osteoporosis (PLO) is a rare, severe, early form of osteoporosis in which young women present with fractures, usually multiple vertebral fractures, during late pregnancy or lactation. In studies of idiopathic osteoporosis (IOP) in premenopausal women, we enrolled 78 women with low‐trauma fractures and 40 healthy controls, all with normal menses and no secondary cause of bone loss. In 15 of the affected women, the PLO subgroup, fractures had occurred during late pregnancy or lactation. We hypothesized that clinical, bone structural, and metabolic characteristics would differ between women with PLO and those with (non‐PLO) IOP and controls. All were evaluated > 12 months postpartum, when structural and remodeling characteristics would be expected to reflect baseline premenopausal status rather than transient postpartum changes. As previously reported, affected subjects (PLO and IOP) had BMD and microarchitectural deficiencies compared to controls. Women with PLO did not differ from those with IOP in terms of age, BMI, body fat, menarcheal age, parity, or age at first pregnancy. However, women with PLO had a more severe clinical presentation than those with IOP: more fractures (5.5 ± 3.3 versus 2.6 ± 2.1; p = 0.005); more vertebral fractures (80% versus 17%; p < 0.001); and higher prevalence of multiple fractures. BMD deficits were more profound and cortical width tended to be lower in PLO. PLO subjects also had significantly lower tissue‐level mineral apposition rate and bone formation rates (0.005 ± 0.005 versus 0.011 ± 0.010 mm2/mm/year; p = 0.006), as well as lower serum P1NP (33 ± 12 versus 44 ± 18 µg/L; p = 0.02) and CTX (257 ± 102 versus 355 ± 193 pg/mL; p = 0.01) than IOP. The finding that women with PLO have a low bone remodeling state assessed more than a year postpartum increases our understanding of the pathogenic mechanism of PLO. We conclude that women with PLO may have underlying osteoblast functional deficits which could affect their therapeutic response to osteoanabolic medications. © 2019 American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Section: Journal Of Bone and Mineral Researchmentioning

confidence: 99%

Section: Journal Of Bone and Mineral Researchmentioning

confidence: 99%

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Women With Pregnancy and Lactation–Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level

Cohen

Kamanda‐Kosseh

Dempster

et al. 2019

Journal of Bone and Mineral Research

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“…W ostatnich latach u wielu kobiet z PLO stosowano terapię teryparatydem (rekombinowany ludzki 1-34 parathormon), wykorzystując jego anaboliczny wpływ na kości [4,20]. Wydaje się, że efekt jest lepszy niż w przypadku bisfosfonianów, poprawa kliniczna następuje dość szybko, a przyrost BMD sięga u niektórych chorych nawet 14-35% [20][21][22][23]. Kojarzono też teryparatyd z bisfosfonianem z dobrym efektem [1,4].…”

Section: Omówienieunclassified

Osteoporoza związana z ciążą i laktacją

Urban-Mocek¹,

Szymczak

2019

Forum Reumatologiczne

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Osteoporoza związana z ciążą i laktacją (PLO, pregnancy and lactation-associated osteoporosis) to rzadko występująca forma osteoporozy premenopauzalnej o zwykle ciężkim przebiegu, niejednoznacznej przyczynie i nieustalonym sposobie leczenia. Manifestuje się jako silny ból kręgosłupa, zaburzenia jego statyki i zmniejszenie wzrostu pod koniec ciąży lub w okresie laktacji, co wynika z niskoenergetycznych złamań trzonów kręgów. Zaprzestanie laktacji i wdrożenie farmakoterapii (witamina D, teryparatyd, bisfosfoniany) skutkuje zwykle ustąpieniem bólu i znaczną poprawą gęstości mineralnej kości. W dalszym przebiegu choroby, kolejne złamania pojawiają się jednak u ponad 20% kobiet. W pracy przedstawiono trudności w diagnostyce i leczeniu osteoporozy powikłanej wieloogniskowymi złamaniami trzonów kręgów piersiowych i lędźwiowych u kobiety z PLO i z przebytą gruźlicą. Leczenie za pomocą teryparatydu i denosumabu przyniosło poprawę, ale nie spowodowało remisji choroby.

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“… 2 The typical clinical features of PLO are low back or hip pain and a decrease in self-awareness of height in the third trimester of pregnancy and postpartum. 3 Fragility fractures may occur in women with severe osteoporosis, and predominantly occur in the thoracolumbar spine. 4 The incidence of PLO is four in 1 million women and many of these patients are misdiagnosed.…”

Section: Introductionmentioning

confidence: 99%

Intertrochanteric fracture in pregnancy- and lactation-associated osteoporosis

Jie

Wang

et al. 2019

J Int Med Res

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Pregnancy- and lactation-associated osteoporosis (PLO) is a special form of osteoporosis, which is the result of multiple factors affecting bone metabolism. The manifestations of PLO include severe low back or hip pain in the third trimester of pregnancy and postpartum period, and some patients present with a decrease in height and even fragility fractures. We report here a 33-year-old patient who presented with a left intertrochanteric fracture after falling from standing height at 10 months postpartum. She was diagnosed with PLO because of a considerable decrease in bone mineral density. Our findings are discussed in relation to the literature. Early diagnosis and timely and appropriate therapy are particularly important for PLO. PLO should be considered in patients who complain of low back or transient hip pain during pregnancy and lactation. Discontinuing breastfeeding and supplementing calcium/vitamin D should be recommended after diagnosis of PLO is established.

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Changes in bone mineral density and bone turnover markers during treatment with teriparatide in pregnancy‐ and lactation‐associated osteoporosis

Abstract: In patients with PLO, LSBMD at 12 months increased in both the TPTD-treated and control groups. TPTD treatment and younger age were associated with greater increases in LSMBD irrespective of baseline LSBMD.

Cited by 52 publications

References 33 publications

Women With Pregnancy and Lactation–Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level

Women With Pregnancy and Lactation–Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level

Osteoporoza związana z ciążą i laktacją

Intertrochanteric fracture in pregnancy- and lactation-associated osteoporosis

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