Pregnancy-associated spinal osteoporosis treated with bisphosphonates: long-term follow-up of maternal and infants outcome

Abstract

Pregnancy-associated spinal osteoporosis (PPSO) is a rare condition characterized by severe back pain occurring near the end of the first pregnancy or shortly afterward. The aim of this report is to present a 12-year follow-up of a patient with PPSO. Also, the outcomes of patient's two pregnancies and her infants after long-term treatment with bisphosphonates are assessed. A young woman was referred to our tertiary care hospital aged 30 years, due to intense pain in thoracic and lumbar region that started during the last month of her first pregnancy and got worse after delivery. Bone mineral density (BMD) measurement, clinical, and biochemical parameters were performed. Extremely low lumbar spine BMD, L2-L4: 0.627 g/cm(2), T-score -4.8, Z-score -4.3, 52% young adult indicated severe osteoporosis. Cyclical treatment with etidronate and then pamidronate was started, and a substantial increase in the BMD and the reduction in back pain intensity were observed. An increase in BMD of 44.8% over baseline was observed after 12 years of follow-up. Her two pregnancies were uneventful, and no neonatal adverse effects were observed. Control DXA scan in her girl child aged 6.8 years revealed low BMD at the lumbar spine. As PPSO seems to be an underdiagnosed severe disease, caution is recommended if back pain occurs in the last trimester or early post-partum period. Although pre-pregnancy use of bisphosponates does not pose a substantial fetal risk, their use in women of childbearing age might best be done only when strong clinical indications exist.

Hypercalcemia in pregnancy – a multifaceted challenge: case reports and literature review

“…No increase in major birth defects or skeletal abnormalities was observed. In long‐term follow‐up, only two infants exposed in utero to bisphosphonates were tested; they were shown to have normal bone density at five and six years of age, respectively 38. In contrast, Losada et al observed a 20% rate of congenital malformations in children of patients with autoimmune rheumatic diseases taking bisphosphonates combined with other medications 33.…”

A Rare Cause of Low Back Pain in Pregnancy: Pregnancy Associated Osteoporosis

“…Otuz gün sonra asemptomatik olan hastanın tedavi sonrası 3. aydaki kontrol MRG'de eski kırıklarda iyileşme görülürken 6. ve 12. ayda tekrarlanan DEXA ölçümlerinde lomber bölgede daha fazla olmak üzere KMY değerlerinde belirgin yükselme tespit edilmiş. Bir başka GİO tanılı olguya (20) siklik etidronat tedavisi (her 3 ayda 400 mg/gün 14 gün) verilmiş. Konsepsiyondan 3 ay önce son dozu almak üzere, etidronat tedavisi devam ederken 2 kez daha gebe kalan hastanın normal geçen gebeliklerinin yanı sıra yenidoğan çocuklarında hipokalsemi veya herhangi bir iskelet anomalisi gelişmemiş.…”

The use of bisphosphonates in women prior to or during pregnancy and lactation

“…The outcome of pregnancy was positive, though no further details were given about neonatal health. 12 Following that report, Athimulam et al 13 and Vujasinovic-Stupar et al 14 presented the outcome of 2 more cases of BPs-exposed women due to PO. In the first case, 13 a 34-year-old woman treated with alendronate after her second delivery, discontinued BPs at the beginning of her third pregnancy.…”