Pregnancy-Associated Osteoporosis: Long-term Follow-up of a Patient with Two Pregnancies

Abstract

Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition. Its pathogenesis and etiology are unknown. It is frequently observed in the last trimester of pregnancy and during lactation period in primigravida. The symptoms may begin with back and hip pain. In addition, it could be complicated by osteoporotic fractures and disability. Here, we report a long-term (7 years) follow-up of a 29-year-old patient who underwent two pregnancies and was diagnosed with PLO both the times. The first time this patient was admitted to our outpatient clinic with a complaint of severe back pain, she was in the lactation period of her first pregnancy. Laboratory findings, X-ray imaging and densitometry revealed osteomalacia (25-OH Vit D = 6.8 ng/dL), multiple vertebral fractures (T6-T9-T11-T12-L1), and osteoporosis (L1-L4 T-score: -4.6). After the treatment for vitamin D deficiency, she was treated with risedronate and Ca-vitamin D supplementation. At the end of the 2-year follow-up, she terminated the use of risedronate [by her own decision] and continued with the Ca-vitamin D supplementation. Six years after the first pregnancy, she became pregnant again. In the postpartum period, she complained about gait difficulty, and severe hip and back pain. With the help of laboratory results, imaging, and densitometry (L1-L4 T-score: -3.9), she was diagnosed with PLO second time, and was treated with zoledronic acid, in addition to Ca-vitamin D supplementation. Once back pain occurs in the postpartum period, PLO should be considered in differential diagnosis even if the patient is taking Ca-vitamin D supplementation.Gebelik ve laktasyon ile ilişkili osteoporoz (GLO) patogenezi ve etyolojisi bilinmeyen nadir bir durumdur. Sıklıkla ilk gebeliğin son üç ayında ve laktasyon periyodunda görülür. Semptomlar bel ve kalça ağrısı ile başlayabilir, osteoporotik kırıklar ve disabilite eşlik edebilir. Bu vaka takdiminde her iki gebeliğinde de GLO teşhis edilen 29 yaşında bir hastanın uzun dönem (7 yıl) takiplerini sunduk. Hasta polikliniğimize şiddetli sırt ağrısı şikayetiyle başvurduğunda ilk gebeliğinin laktasyon periyodundaydı. Laboratuar bulguları, X-ray görüntüleme ve dansitometri sonucunda osteomalazi (25-OH Vit D= 6.8 ng/dL), multiple vertebra kırıkları (T6-T9-T11-T12-L1) ve osteoporoz (L1-L4 T-score: -4.6) tespit edildi. Tedavisine, D vitamini replasmanı sonrası risedronat ve Ca-D vitamin ile devam edildi. İki yıllık takibin sonunda hasta (kendi isteğiyle) risedronat kullanımını keserek Ca-D vitamini kullanmayı sürdürdü. Ilk gebeliğinden altı yıl sonra tekrar gebe kaldı. Postpartum periyodda yürüme güçlüğü, şiddetli sırt ve kalça ağrısı yakınmaları olan hastaya laboratuar, görüntüleme ve dansitometri (L1-L4 T-score: -3.9) bulgularının sonucunda ikinci defa GLO tanısı konuldu. Hastaya Ca-D vitamini takviyesine ek olarak zoledronik asit tedavisi uygulandı. Postpartum periyodda sırt ağrısı ile başvuran hastalarda; hasta Ca-D vitamini takviyesi kullansa bile ayırıcı tanıda GLO akla gelmelidir.

Comparative Effectiveness of Therapeutic Interventions in Pregnancy and Lactation-Associated Osteoporosis: A Systematic Review and Meta-analysis

“…Risedronate increased FN BMD by 3.4% to 65.0% and 3.3% at 12 and 24 months, respectively. In the same case ( 67 ), FN BMD changes after 24 months of risedronate therapy were +3.3% and −3.3% at 36 and 72 months, respectively.…”

“…Risedronate increased LS BMD by 13.4% to 34.2% and 38.9% at 12 and 24 months of therapy, respectively. In 1 case ( 67 ), LS BMD continued to increase further after therapy discontinuation at 24 months (38.9% and 43.% at 36 and 72 months, respectively). Risedronate increased FN BMD by 3.4% to 65.0% and 3.3% at 12 and 24 months, respectively.…”