Treatment with teriparatide in a patient with pregnancy-associated osteoporosis

Hellmeyer, L; Boekhoff, Jelena; Hadji, Peyman

doi:10.3109/09513591003649831

Cited by 52 publications

(26 citation statements)

References 19 publications

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“…To our knowledge, there are three articles reporting the outcomes of TRP treatment in PLO. 2,23,24 In one patient, after 18 months of therapy, the increase of BMD at the spine and total hip was 36% and 13.8%, respectively. 24 In a small case series, three PLO patients improved their BMD by 14.5-25% at the lumbar spine and 13.4-17.9% at the total hip.…”

Section: Discussionmentioning

confidence: 99%

“…2,23,24 In one patient, after 18 months of therapy, the increase of BMD at the spine and total hip was 36% and 13.8%, respectively. 24 In a small case series, three PLO patients improved their BMD by 14.5-25% at the lumbar spine and 13.4-17.9% at the total hip. 2 In summary, women with PLO may suffer from vertebral fragility fracture(s), often multiple, which cause severe and disabling back pain and kyphosis in the third trimester of pregnancy or in early postpartum.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Teriparatide treatment in a case of severe pregnancy -and lactation- associated osteoporosis

Lampropoulou-Adamidou¹,

Trovas²,

Stathopoulos³

et al. 2012

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OBJEcTIVE: Pregnancy-and lactation-associated osteoporosis (PLO) is an uncommon disease. The majority of cases are seen in the third trimester or early post-partum in primagravid women and the prominent clinical feature of PLO is severe and prolonged back pain and height loss. The prevalence and aetiology of this disorder are as yet unclear and there are no guidelines for its treatment. cAsE rEPOrT: We report the outcomes of teriparatide (TrP) treatment in a woman suffering from severe PLO with 6 vertebral fragility fractures, severe back pain and very low BMD. rEsULTs: Thirteen months after the initiation of therapy, the patient was almost free of back pain. There was no new clinical vertebral fracture. Her laboratory tests were all normal. BMD increased by 24.4% at the lumbar spine, 9.9% and 4.6% at the left and the right total hip and 12.6% and 7.8% at the left and right femur neck, respectively. cONcLUsION: TrP treatment simultaneously with weaning and calcium and vitamin D supplementation seems to considerably increase BMD, improve severe back pain and quality of life and prevent further occurrence of vertebral fractures, making TrP a helpful tool in restoring bone strength in PLO patients. Key words: Lactation, Osteoporosis, Pregnancy, Premenopausal osteoporosis, TeriparatideCase report HORMONES 2012, 11(4):495-500 Address for correspondence: Kalliopi Lampropoulou-Adamidou, MD, MSc, Laboratory for the Research of the Musculoskeletal System "Th. Garofalidis", KAT General Hospital of Athens, 10 Athinas Str., 14561, Kifissia, Athens, Greece, Tel.: +306984229202, +302108018123, Fax: +302108018122, E-mail: kilampropoulou@gmail.com of PLO was made by Nordin et al in 1955. 1 It is characterised by the occurrence of fragility fracture(s), most commonly involving the lower thoracic and/ or lumbar vertebral bodies. The majority of cases are seen in the third trimester or early post-partum in primagravid women and the prominent clinical feature of PLO is severe and prolonged back pain and height loss. The prevalence and the ae tiology of this disorder are unclear. To date, more than 120 cases have been reported, mostly as individual case reports.2 Due to the lack of controlled trials and the rarity of the disease there are no formal guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case Report: Teriparatide treatment in a case of severe pregnancy -and lactation- associated osteoporosis

Lampropoulou-Adamidou¹,

Trovas²,

Stathopoulos³

et al. 2012

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“…As noted earlier, individual case reports have described use of nasal calcitonin (263,687,885), bisphosphonates (43,143,178,263,438,475,671,677,685,799,885,897), strontium ranelate (897,1016), and teriparatide (98,178,377,527,544,885) to treat osteoporosis diagnosed during pregnancy or lactation. In each of these uncontrolled cases, the achieved BMD increase was assumed to be due to pharmacological therapy, but remained within the expected range of increase that can occur spontaneously during postweaning recovery.…”

Section: Human Datamentioning

confidence: 99%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

383

524

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During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ϳ30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

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“…The recent use of teriparatide has been followed by a remarkable increase in BMD at both the spine and the hip in a few cases with vertebral fractures diagnosed at post partum or within the lactation period (97,98,99).…”

Section: -454 With Permission) European Journal Of Endocrinologymentioning

confidence: 99%

“…Severe osteoporosis (97) Measurement of BMD with DXA will show either osteopenia or evident osteoporosis, which may be accompanied by vertebral deformities or vertebral collapse. Conventional radiography will confirm the fracture in most cases (85,86).…”

Section: Diagnosismentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

Sanz-Salvador

Garcı́a-Pérez

Tarı́n

et al. 2015

European Journal of Endocrinology

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Changes in bone density and bone markers suggest that pregnancy is associated with deterioration of bone mass in the mother. The metabolism of calcium resets to allow for the needs imposed by the building of the fetal skeleton. The fetus contributes to the process through the output of regulators from the placenta. Understanding of the whole process is limited, but some changes are unambiguous. There is an increase in the circulating levels of vitamin D, but its functional impact is unclear. Fetal parathyroid hormone (PTH) and PTH-related peptide (PTHrp) play an indirect role through support of a calcium gradient that creates hypercalcemia in the fetus. Placental GH, which increases up to the end of pregnancy, may exert some anabolic effects, either directly or through the regulation of the IGF1 production. Other key regulators of bone metabolism, such as estrogens or prolactin, are elevated during pregnancy, but their role is uncertain. An increase in the ratio of receptor activator of nuclear factor kappa B ligand (RANKL) to osteoprotegerin (OPG) acts as an additional pro-resorbing factor in bone. The increase in bone resorption may lead to osteoporosis and fragility fracture, which have been diagnosed, although rarely. However, the condition is transitory as long-term studies do not link the number of pregnancies with osteoporosis. Prevention is limited by the lack of identifiable risk factors. When fractures are diagnosed, rest, analgesics, or, when indicated, orthopedic intervention have demonstrated efficacy. Systemic treatment with anti-osteoporotic drugs is effective, but the potential harm to the fetus imposes caution in their use.

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Treatment with teriparatide in a patient with pregnancy-associated osteoporosis

Abstract: Our report demonstrates the successful use of teriparatide underlined by the increase of bone mineral density and the improvement of clinical symptoms in a case of severe pregnancy-associated osteoporosis for the first time.

Cited by 52 publications

References 19 publications

Case Report: Teriparatide treatment in a case of severe pregnancy -and lactation- associated osteoporosis

Case Report: Teriparatide treatment in a case of severe pregnancy -and lactation- associated osteoporosis

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

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