Risk factors, fractures, and management of pregnancy-associated osteoporosis: a retrospective study of 14 Turkish patients

Tuna, Filiz; Akleylek, Cansu; Özdemir, Hande; Kabayel, Derya Demirbağ

doi:10.1080/09513590.2019.1648417

Cited by 17 publications

(17 citation statements)

References 24 publications

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“…These events significantly affect the rate of bone turnover, which lead to osteopenia and osteoporosis, and finally to bone fractures. Osteoporosis is more commonly associated with aging; however, it has been proven that increased bone loss occurs in women after pregnancy and lactation [ 1 , 2 , 3 , 49 , 50 ]. Pregnancy and lactation are physiological states which occur during a woman’s lifetime; however, both are very specific.…”

Section: Discussionmentioning

confidence: 99%

Femoral µCT Analysis, Mechanical Testing and Immunolocalization of Bone Proteins in β-Hydroxy β-Methylbutyrate (HMB) Supplemented Spiny Mouse in a Model of Pregnancy and Lactation-Associated Osteoporosis

Tomaszewska

Muszyński

Donaldson

et al. 2021

JCM

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A metabolite of leucine, ß-hydroxy-ß-methylbutyrate (HMB), used as a dietary supplement effects muscle tissue gain and bone tissue quality. Since there are no studies on the effects of HMB during pregnancy yet, the aim of the current study was to determine the effects of HMB supplementation during pregnancy on osteoporotic bone quality postpartum and post-lactation using spiny mice (Acomys cahirinus) as the animal models. The six-month-old dams were divided into four groups: pregnant and lactating controls, and pregnant and lactating HMB-treated (during the second trimester of pregnancy) females. The intensity of the immunoreaction of osteocalcin (OC), osteoprotegerin (OPG), bone morphogenetic protein 2 (BMP-2), tissue inhibitor of metalloproteinases 2 (TIMP-2), matrix metalloproteinase 8 and 13 (MMP-8 and MMP-13) and proteins involved in bone turnover, was measured in femoral trabecular and compact bone, as well as in the hyaline and epiphyseal cartilage of the femora. The analysis of the trabecular bone microarchitecture showed that the administration of HMB to pregnant females, by influencing the proteins responsible for bone cell activity and collagen remodeling, can provide protection from bone loss. Based on the results of the current study it can be assumed that HMB administration to pregnant females has a more positive impact on trabecular than compact bone.

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Section: Discussionmentioning

confidence: 99%

Femoral µCT Analysis, Mechanical Testing and Immunolocalization of Bone Proteins in β-Hydroxy β-Methylbutyrate (HMB) Supplemented Spiny Mouse in a Model of Pregnancy and Lactation-Associated Osteoporosis

Tomaszewska

Muszyński

Donaldson

et al. 2021

JCM

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“…In the literature, there are case reports using different pharmacological treatments such as bisphosphonates, teriparatide, calcitonin, denosumab, strontium ranelate in PLO treatment ( Hadji et al, 2017 ; Laroche et al, 2017 ; Zarattini et al, 2014 ; Sánchez et al, 2016 ; Choe et al, 2012 ; Polat et al, 2015 ; Ozdemir et al, 2015 ; Tuna et al, 2019 ; O'Sullivan et al, 2006 ; Tanriover et al, 2009 ; Adamidou et al, 2012 ; Hong and Rhee, 2019 ). In the series (n = 52) of Larosche et al 35% of patients received only conservative treatment, 62% received both conservative and specific pharmacological treatment (17% bisphosphonate, 21% teriparatide, 4% strontium ranelate and 4% calcitonin).…”

Section: Discussionmentioning

confidence: 99%

A case of pregnancy and lactation associated osteoporosis in the third pregnancy; robust response to teriparatide despite delayed administration

Cerit

2020

Bone Reports

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Background Pregnancy and lactation associated osteoporosis (PLO) is a rare condition that may present with fragility fractures occurring for the first time in pregnancy or postpartum period while breastfeeding. Here, we report a rare case of PLO in the 3rd pregnancy treated with teriparatide. Case report A 35-year-old woman who presented with back pain (visual analogue scale; VAS = 10/10) two months after her third delivery. PLO was diagnosed from multiple vertebral fragility fractures and low bone mineral density (BMD). She was treated with teriparatide and her pain significantly reduced in the second month. After 12 months of teriparatide treatment, her BMD increased 18.1% from the baseline. Conclusion PLO should be considered in patients who complain with back pain during late pregnancy and postpartum period. Weaning off breastfeeding and supplementation of calcium/vitamin D should be the first recommendation as conventional treatment after the diagnosis of PLO. Teriparatide may be an effective option to improve the recovery of BMD If there is not enough improvement with conventional treatment.

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“…A literature search revealed no RCT but case reports and retrospective analysis on treatment effect in women with PLO. Hereby, several authors suggested that a bone-forming treatment using teriparatide could be an effective treatment option [ 1 , 4 , 7 – 10 ]. As this is an off-label treatment and the health care provider was not willing to accept the high expenses of a teriparatide treatment in our patient, an off-label antiresorptive treatment with denosumab (Prolia, 60 mg/every 6 months s.c.) was initiated.…”

Section: Case Presentationmentioning

confidence: 99%

“…Lumbopelvic pain (LPP) is one of the most frequent skeletal disabling symptoms in pregnancy with a frequency of around 58–65%. Beside many, one infrequent reason for LLP is pregnancy and lactation-associated osteoporosis (PLO) with predominantly subsequent vertebral and non-vertebral fractures [ 1 , 2 ]. The incidence of this rare but severe disease is estimated at 0.4 in 100,000 [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis

2021

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Pregnancy and lactation-associated osteoporosis (PLO) with predominantly subsequent vertebral fracture is a rare but severe disease with an estimated incidence of 0.4 in 100,000. In the past, patients with PLO have been predominantly treated with oral and i.v. bisphosphonates to reduce subsequent fracture risk. Hereby, the use of bisphosphonates in premenopausal women is controversial, as bisphosphonates know to persist in bone for many years and can be exposed and circulate in maternal serum and subsequently pass the placenta barrier and may have a detrimental effect on fetal bone health. Here we report the effects of denosumab on the bone mineral density (BMD) and subsequent fracture risk in PLO. In this case presentation, denosumab was administered postpartum with 3000 IE vitamin D and 1000 mg of calcium daily in a patient with PLO and vertebral fracture of L1 and L4. After 18 months of treatment with denosumab, we could demonstrate a clinical significant increase of BMD at the lumbar spine, femoral neck, and total hip of 32.2%, 13.0%, and 11.5% respectively with no further subsequent fractures. As the patient had regular menstrual cycles and considered a further pregnancy, denosumab treatment was terminated and soon a second pregnancy occurred. After the second pregnancy, BMD decreased at the lumbar spine, femur neck, and total hip by −8.8%, −6.9%, and −7.0% respectively compared to the maximum values during treatment with denosumab, but was still significantly higher compared to baseline levels with no further fractures.

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Risk factors, fractures, and management of pregnancy-associated osteoporosis: a retrospective study of 14 Turkish patients

Cited by 17 publications

References 24 publications

Femoral µCT Analysis, Mechanical Testing and Immunolocalization of Bone Proteins in β-Hydroxy β-Methylbutyrate (HMB) Supplemented Spiny Mouse in a Model of Pregnancy and Lactation-Associated Osteoporosis

Femoral µCT Analysis, Mechanical Testing and Immunolocalization of Bone Proteins in β-Hydroxy β-Methylbutyrate (HMB) Supplemented Spiny Mouse in a Model of Pregnancy and Lactation-Associated Osteoporosis

A case of pregnancy and lactation associated osteoporosis in the third pregnancy; robust response to teriparatide despite delayed administration

Influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis

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