Long-term outcome of patients with pregnancy and lactation-associated osteoporosis (PLO) with a particular focus on quality of life

Gehlen, Martin; Lazarescu, Ana Doina; Hinz, Christian; Schwarz-Eywill, M; Pfeifer, Michael; Balasingam, Subathira; Maier, Anna

doi:10.1007/s10067-019-04758-0

Cited by 30 publications

(30 citation statements)

References 22 publications

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“…Vertebral fractures presenting with back pain should be treated with appropriate pain medication and advice on weight bearing and mobility. Quality of life and capacity to work should also be taken into account, although long-term prognosis for PLO is good ( 132 ). In general, pharmacological treatment for low bone mass is not indicated, except calcium and vitamin D supplements, since bone mass recovers fully in the year following weaning and the onset of the menstrual cycle ( 3 ).…”

Section: Physiological Adaptation Of Bone To Pregnancy and Lactationmentioning

confidence: 99%

Pregnancy and lactation, a challenge for the skeleton

Winter

Ireland

Butterfield

et al. 2020

Endocrine Connections

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In this review we discuss skeletal adaptations to the demanding situation of pregnancy and lactation. Calcium demands are increased during pregnancy and lactation, and this is effectuated by a complex series of hormonal changes. The changes in bone structure at the tissue and whole bone level observed during pregnancy and lactation appear to largely recover over time. The magnitude of the changes observed during lactation may relate to the volume and duration of breastfeeding and return to regular menses. Studies examining long-term consequences of pregnancy and lactation suggest that there are small, site-specific benefits to bone density and that bone geometry may also be affected. Pregnancy- and lactation-induced osteoporosis (PLO) is a rare disease for which the pathophysiological mechanism is as yet incompletely known; here, we discuss and speculate on the possible roles of genetics, oxytocin, sympathetic tone and bone marrow fat. Finally, we discuss fracture healing during pregnancy and lactation and the effects of estrogen on this process.

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Section: Physiological Adaptation Of Bone To Pregnancy and Lactationmentioning

confidence: 99%

Pregnancy and lactation, a challenge for the skeleton

Winter

Ireland

Butterfield

et al. 2020

Endocrine Connections

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“…The risk of fracture is generally low among premenopausal women 14 ; however, there are rare cases, estimated at a prevalence of 4-8 per 1 million pregnancies, of pregnancy-and lactation-associated osteoporosis. 41,42 Unlike most premenopausal women, this small group of patients are at increased immediate risk for fracture. As risk of fracture naturally increases with age, most studies correlating pregnancy and lactation with fracture risk do so in postmenopausal women.…”

Section: Lactationmentioning

confidence: 99%

Bone Mineral Density Changes Associated With Pregnancy, Lactation, and Medical Treatments in Premenopausal Women and Effects Later in Life

Watts

Binkley

Owens

et al. 2021

Journal of Women's Health

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Bone mineral density (BMD) changes during the life span, increasing rapidly during adolescence, plateauing in the third decade of life, and subsequently entering a phase of age-related decline. In women, menopause leads to accelerated bone loss and an increase in fracture risk. Between peak bone mass attainment and menopause, BMD is generally stable and the risk of fracture is typically low. This time period is marked by life events such as pregnancy and lactation, which transiently decrease BMD, yet their long-term effects on fracture risk are less certain. BMD may also be altered by exposure to medications that affect bone metabolism (e.g., contraceptives, glucocorticoids, antidiabetic medications, antiepileptic drugs). Although oral contraceptives are often believed to be neutral with regard to bone health, depot medroxyprogesterone acetate (DMPA) and gonadotropinreleasing hormone (GnRH) agonists have been associated with decreases in BMD. Development of newer medical therapies, principally GnRH antagonists (e.g., ASP1707, elagolix, linzagolix, relugolix), for treatment of endometriosis-associated pelvic pain and heavy menstrual bleeding due to uterine fibroids has renewed interest in the short-and long-term impacts of changes in BMD experienced by premenopausal women. It is important to understand how these drugs influence BMD and put the findings into context with regard to measurement variability and naturally occurring factors that influence bone health. This review summarizes what is known about the effects on bone health pregnancy, lactation, and use of DMPA, GnRH agonists, and GnRH antagonists in premenopausal women and potential consequences later in life. ClinicalTrials.gov identifier: NCT03213457.

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“…34 The prognosis of PLO is good, although it causes great pain and inconvenience. 36 Gehlen et al found that 20 patients of PLO improved within the first 2 years and it took them 3.3 years on average time to return to employment. 36 In our case, the results of laboratory tests and DEXA gradually returned to normal during the 1-year follow-up period.…”

Section: Dovepressmentioning

confidence: 99%

“…3 Many cases of PLO associated with vertebral compression fractures or hip fractures have been reported. [4][5][6] In contrast, distal radius fractures in patients with PLO are rarely reported. We report here a 36-yearold patient who presented with Barton fracture of the distal radius after suffering from minor trauma at 37 weeks of gestation.…”

Section: Introductionmentioning

confidence: 99%

<p>Barton Fracture of the Distal Radius in Pregnancy and Lactation-Associated Osteoporosis: A Case Report and Literature Review</p>

Wang¹,

Bai²

2020

IJGM

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Objective: Pregnancy and lactation-associated osteoporosis (PLO) is very rare, which typically occurs during the third trimester or during lactation. Many cases of PLO are associated with vertebral compression fractures or hip fractures, while distal radius fractures in patients with PLO are rarely reported. Case Report: A 36-year-old patient presented with Barton fracture at 37 weeks of gestation. Temporary closed reduction and plaster external fixation were performed in emergency room. At 38 weeks of gestation, she gave birth to a healthy boy and began breastfeeding after delivery. Three days after delivery, the patient was admitted to the orthopedic ward for surgery and was diagnosed as PLO. The patient underwent open reduction and internal fixation and treated with weaning and supplementation of calcium carbonate and vitamin D. During the 1-year follow-up period, the results of laboratory tests and bone mineral density gradually returned to normal. Conclusion: Clinicians should be alert to the possibility of PLO to avoid missed diagnosis. Accurate diagnosis and individualized treatment are of great significance for relieving pain and functional recovery of patients.

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Long-term outcome of patients with pregnancy and lactation-associated osteoporosis (PLO) with a particular focus on quality of life

Cited by 30 publications

References 22 publications

Pregnancy and lactation, a challenge for the skeleton

Pregnancy and lactation, a challenge for the skeleton

Bone Mineral Density Changes Associated With Pregnancy, Lactation, and Medical Treatments in Premenopausal Women and Effects Later in Life

<p>Barton Fracture of the Distal Radius in Pregnancy and Lactation-Associated Osteoporosis: A Case Report and Literature Review</p>

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