Transient osteoporosis in the third trimester of pregnancy: A case report

Bhakta, Ankita

doi:10.1016/j.crwh.2022.e00400

Cited by 2 publications

(6 citation statements)

References 12 publications

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“…However, a low BMD is generally expected; previous reports showed a mean DXA Z-score of −3.2 SD (lowest value of −7.8 SD) [74]. We found Z-score values varying from −2.2 SD to −4 SD [23,44,51,59,60,62,65].…”

Section: Gap 6: Multidisciplinary Tools To Diagnose Pao/laosupporting

confidence: 39%

“…Overall, in addition to 24 new (single) case reports [23,44,51,[55][56][57][58][59][60][61][62][63][64][65][66][67][68], we identified 12 original studies (with at least 6 patients with PAO/LAO per study): 1 study was published in 2023 (within the first 3 months of the year), 5 were published in 2022, and 6 in 2021. Except for one survey [43], these were retrospective cohorts (one being a nationwide study in Japan) [41].…”

Section: Discussionmentioning

confidence: 99%

“…TOH, a self-limited condition of late pregnancy or the early postpartum period (but rare reports of TOH in children and middle-aged men are also found) of mostly unknown cause, represents a major cause of dramatic hip pain during this time. MRI is the diagnostic method of choice during pregnancy and, once confirmed, it becomes a comorbidity that should be taken into consideration when deciding the timing and type of delivery (some consider TOH as an indication of emergency cesarean) [38,[50][51][52][53][54]. For example, one case of TOH reported a bilateral femoral neck fracture during week 34 of gestation; emergency caesarean was provided to the 24-year-old patient followed by bilateral closed reduction and internal fixation (dynamic hip screws), followed by hip replacement on the left side due to fixation failure.…”

Section: Transient Osteoporosis Of the Hip (Toh)mentioning

confidence: 99%

“…TOH-associated pain brings a rather low index of suspicion, and no standard management is recommended; a conservative approach in late pregnancy should be firstly advised after careful consideration by a multidisciplinary team. Postpartum spontaneous recovery is reported within an average of 6 weeks [38,50,51].…”

Section: Transient Osteoporosis Of the Hip (Toh)mentioning

confidence: 99%

“…Case reports (one patient per study) concerning PAO/LAO displayed starting with (please see references[23,44,51,[55][56][57][58][59][60][61][62][63][64][65][66][67][68]). …”

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confidence: 99%

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Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis

Cârșote

Turturea²,

Valea

et al. 2023

Diagnostics

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Early diagnosis of pregnancy- and lactation-associated osteoporosis (PLO) is mandatory for a good outcome. Standard care is not a matter of conventional guidelines, rather it requires an individualized strategy while true overall incidence and pathogeny remain open issues. This is a narrative review based on full-length English articles, published between January 2021 and March 2023 and accessed via PubMed (no traumatic fractures or secondary osteoporosis are included). Our case-sample-based analysis included 836 females with PLO (the largest cohort based on published cases so far) through 12 studies and 24 single case reports. Except for one survey, these involved retrospective cohorts of small size (6–10 females/study) to medium size (23–47 women/study), and large cohorts with >50 subjects per study (a maximum of 379). Age of diagnosis: from 24 to 40 years for case reports (most subjects being over 30 and primigravida), while original studies indicated an average age between 31 and 34.18 years. Type of fractures underlined a most frequent vertebral phenotype (a mean of 2 to 5.8 vertebral fractures per patient) versus a most severe non-vertebral phenotype (hip and femoral neck fractures mostly requiring surgery). Potential contributors varied: smoking (1/3–1/2 of subjects), family history of osteoporosis (1/3), heparin and glucocorticoid use in pregnancy, low body mass index (majority of cases), hypovitaminosis D; and (with a low level of statistical significance) anti-psychotic medication, gestational diabetes, lupus, thrombophilia, anemia, in vitro fertilization (1/3 in one study), twin pregnancy, tocolysis with MgSO4, and postpartum thyroiditis. Most remarkably, up to 50% of PLO patients harbor mutations of LRP5, WNT1, and COL1A1/A2 (more damaged form with potential benefits from osteoanabolic drugs); gene testing might become the new norm in PLO. The low index of clinical suspicion should be supported by performing magnetic resonance imaging (gold standard in pregnancy) with DXA (in lactation). Low bone mineral density is expected (Z-score varying from −2.2 SD to −4 SD, unless normal which does not exclude PLO). Bone turnover markers might be useful in individuals with normal DXA, in pregnancy when DXA cannot be performed, and in following the response to anti-osteoporosis drugs. Alternatively, microarchitecture damage might be reflected by DXA-trabecular bone score and high-resolution peripheral quantitative computed tomography. Specific medical interventions are currently focused on teriparatide (TPT) use (3 studies; n = 99 females treated with TPT and an additional subgroup of 18 patients from the gene-analysis-based study, thus a total of 117 females) which seems to be the therapy of choice as reflected by these new data: 6–24 months, 20 µg/day, no sequential therapy needed; case selection based on high fracture risk is necessary). The first case using romosozumab was reported in 2022. PAO/LAO remains a challenging condition which is a battle for the wellbeing of two individuals, on one hand, considering maternal-fetal outcomes and taking care of the offspring, but it is a battle for a multidisciplinary team, on the other hand, since a standardized approach is lacking.

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Section: Gap 6: Multidisciplinary Tools To Diagnose Pao/laosupporting

confidence: 39%

Section: Discussionmentioning

confidence: 99%

Section: Transient Osteoporosis Of the Hip (Toh)mentioning

confidence: 99%

Section: Transient Osteoporosis Of the Hip (Toh)mentioning

confidence: 99%

“…Case reports (one patient per study) concerning PAO/LAO displayed starting with (please see references[23,44,51,[55][56][57][58][59][60][61][62][63][64][65][66][67][68]). …”

mentioning

confidence: 99%

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Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis

Cârșote

Turturea²,

Valea

et al. 2023

Diagnostics

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A Case of Bilateral Transient Pregnancy-Related Osteoporosis of the Hip Diagnosed Late During the Lactation Period: A Rare Clinical Presentation and a Mini Review of the Literature

Thanasa,

Antoniou

et al. 2024

Cureus

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Transient pregnancy-related osteoporosis of the hip is a rare, idiopathic, benign, and usually self-limiting condition caused by edema of the bone marrow, which can be visualized on magnetic resonance imaging. Bilateral localization of the disease is even less common. Our case concerns a 31-year-old primigravida who, during the 35th week of pregnancy, was hospitalized at the Obstetrics and Gynecology Clinic of the General Hospital of Trikala with lumbar and hip pain. The pain gradually increased in intensity and was accompanied by severe movement limitation. No history of falls or injury was reported. Her personal history was unremarkable, and the course of the pregnancy was uneventful. A clinical examination by a team of orthopedic surgeons established a diagnosis of acute hip and back pain. Rest and administration of paracetamol did not improve her clinical condition. During the postpartum and lactation period, the lack of symptom relief led to the decision to further evaluate the patient. The diagnosis of pregnancy-related transient osteoporosis of both hips was established by magnetic resonance imaging. Immediate treatment with bisphosphonate medication after the discontinuation of breastfeeding led to a definitive remission of the symptoms three months later. In this study, after the case description, a brief literature review of this rare clinical entity is presented. Proper knowledge of this condition helps to provide the best possible short- and long-term prognostic outcomes for the mother, fetus, and newborn.

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Transient osteoporosis in the third trimester of pregnancy: A case report

Cited by 2 publications

References 12 publications

Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis

Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis

A Case of Bilateral Transient Pregnancy-Related Osteoporosis of the Hip Diagnosed Late During the Lactation Period: A Rare Clinical Presentation and a Mini Review of the Literature

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