Pregnancy-related osteoporotic vertebral compression fractures in two patients treated with low-molecular-weight heparin during pregnancy: case reports

Abstract

Pregnancy-related osteoporosis (PRO) is an uncommon metabolic bone disease that can result in vertebral fragility fractures. Here we report two cases of young women who had been previously treated with LMWH-enoxaparin and were diagnosed with PRO with vertebral fragility fractures after delivery. In first case report, a 33-year-old primigravid woman who was treated with 40 mg/day of enoxaparin for eight months to prevent venous thromboembolism was presented. After delivery, Dual energy X ray absorptiometry (DEXA) revealed osteoporosis in lumbar and femoral neck region. In magnetic resonance imaging (MRI), T4-T7 thoracic vertebral height losses were detected. In second case report, a 28-year-old primigravid woman which was treated with 40 mg/day enoxparin from the second month to the birth was presented. Osteoporosis in lumbar region was detected by DEXA. MRI revealed T12-L1 and L5 vertebral height losses. In conclusion, PRO can cause severe low back pain and should be considered in differential diagnosis. A detailed medical history should be essential to detect relationship between LMWH and PRO.

Pregnancy‐associated osteoporosis following in vitro fertilization: A case report

“…3,4 There are reports of PAO in women treated with enoxaparin. 5,6 In contrast, an observational cohort study of 152 women who had received LMWH during pregnancy concluded that LMWH use was not associated with a subsequent decrease in BMD and osteoporotic fractures. 7 In the largest case series of PAO, which compared 102 PAO patients with 102 healthy controls, LMWHs were not introduced as a risk factor.…”

“…Although heparin has mainly been implicated as a risk factor for PAO, several animal studies have shown that low molecular heparins (LMWHs) like enoxaparin dose dependently inhibit osteoblasts proliferation and impairs the mechanical properties of bone 3,4 . There are reports of PAO in women treated with enoxaparin 5,6 . In contrast, an observational cohort study of 152 women who had received LMWH during pregnancy concluded that LMWH use was not associated with a subsequent decrease in BMD and osteoporotic fractures 7 .…”

Acute Osteoporosis Postpartum in a Twin Pregnancy: A Case Report

“…There is a dearth of informarion about acute postpartum osteoporosis mainly when the patient have not Received any kind of heparin. Recently, Osturk et al [1] have informed about two cases of osteoporotic disease during pregnancy but associated to the heparin administration. He reported two cases of vertebral fractures diagnosed by Nuclear Magnetic Resonance (RMN).…”