Pregnancy- and lactation-associated osteoporosis with vertebral fractures

Abstract

Introduction. Pregnancy- and lactation- associated osteoporosis (PLO) is a rare disease for which the pathophysiological mechanism is as yet incompletely known. The incidence of PLO is 0.4 in 100,000 women. It is considered that the number of undiagnosed patients is even higher. PLO can lead to multiple fragility compression fractures in the spinal vertebrae. Case outline. We present the case of a 30 years old woman (first-born, breastfeeding child) who comes for examination due to lower back pain that occurs after childbirth without any apparent cause. The patient was found to have low levels of vitamin D and low bone mineral density on osteodensitometry (established osteoporosis). Magnetic resonance imaging (MRI) examination showed vertebral bodies fractures Th11, Th12 and L4. In therapy we used Vitamin D (800 iu/24 h), Alendronate (70 mg once weekly), calcium 1000 mg/24h and Thoracic Lumbar Sacral Orthosis (TLSO) as support to spine. After 12 months of treatment osteodensitometry findings were close to normal, control MRI showed no further collapse of vertebral bodies and clinical examination of spine was orderly. Conclusion. PLO is a rare clinical condition and it must be kept in mind in the differential diagnosis in patients having low back pain during or after pregnancy. Early diagnosis and treatment of PLO and regular follow-up of these cases are particularly important. The stability of the spine in patients with vertebral fractures must be carefully monitored as well as using the TLSO as a support for the spine.