Two cases of pregnancy- and lactation-associated osteoporosis successfully treated with denosumab

Sánchez, Ariel; Zanchetta, María Belén; Danilowicz, Karina

doi:10.1016/j.bone.2017.03.009

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…As has already been demonstrated in other metabolic bone diseases, the trabecular bone is the most metabolically active, and it is affected earlier than the more compact cortical bone. ( 16,17 ) However, the cortical bone compartment was also severely affected in our patients, probably due to the long duration of the disease with a median time of 7.6 years (3.3–18). Similar to our findings, in a biopsy sample from a patient with long‐lasting TIO (12 years), the mineralized trabecular bone matrix exhibited a significant reduction in mineral concentration whereas the heterogeneity of mineralization was substantially increased.…”

Section: Discussionmentioning

confidence: 76%

“…( 21 ) On the contrary, patients with celiac disease and pregnancy and lactation‐associated osteoporosis showed more profound deterioration at the radius than at the tibia. ( 16,17 ) In the latter scenarios, it seems that when mobility is not affected, weight bearing bones could be protected from the metabolic disturbance. This might be due to the mechanostat mechanism.…”

Section: Discussionmentioning

confidence: 99%

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Impaired bone microarchitecture and strength in patients with tumor-induced osteomalacia

Zanchetta

Jerkovich

Nuñez

et al. 2020

Journal of Bone and Mineral Research

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Some studies based on bone biopsy have demonstrated that in patients with tumor‐induced osteomalacia (TIO) the mineralization process of the bone matrix is profoundly disturbed. However, the interrelationship between clinical and biochemical features and bone microarchitecture in this disease needs further analysis. With this purpose in mind, we set out three objectives: (i) to determine bone microarchitecture and estimated bone strength in a group of patients with tumor‐induced osteomalacia using high‐resolution peripheral quantitative computed tomography (HR‐pQCT) and finite element analysis (FEA), (ii) to investigate correlations between duration of disease, biochemical features, bone density, HR‐pQCT and FEA parameters, and (iii) to compare HR‐pQCT and FEA parameters with a healthy control group. Ten patients with TIO were included. All patients had non‐resolved disease. At the distal radius, all bone microarchitecture parameters were significantly affected in patients with TIO in comparison with healthy controls. At the distal tibia, all parameters were significantly impaired, except for trabecular thickness. All the parameters were more affected in the distal tibia than in the distal radius. Women with TIO (n = 7) had significantly lower bone strength parameters than healthy controls. In men (n = 3), bone strength parameters were significantly lower than in the control group at the distal tibia. Alkaline phosphatase levels exhibited a negative correlation with microarchitecture parameters, failure load, and stiffness. Higher levels of parathyroid hormone correlated with poorer microarchitecture parameters. We believe that in TIO, hormonal disturbances and the lack of mechanical stimulus specially converge to generate an extremely harmful combination for bone health. © 2021 American Society for Bone and Mineral Research (ASBMR).

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Impaired bone microarchitecture and strength in patients with tumor-induced osteomalacia

Zanchetta

Jerkovich

Nuñez

et al. 2020

Journal of Bone and Mineral Research

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“…Recently, the use of denosumab has also been suggested, with satisfactory results (71) In one of the two patients in the study, kyphoplasty was initially performed, following immediate post-operative treatment with denosumab, and her bone strength was confirmed through HR-pQCT.…”

Section: Conservative Treatmentmentioning

confidence: 99%

Gestational osteoporosis: Myth or true?

George A. Komnos,

Dionyssios Paridis,

Christos Donoudis

et al. 2024

Int. J. Biol. Pharm. Res. Updates

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Gestational osteoporosis is an existent rare clinical disease presenting with vertebral fractures and is quite often underdiagnosed. Etiology is heterogeneous and risk factors include family history of osteoporosis, low body mass index individuals, women with low physical activity, smoking, failure to achieve maximum bone mass and low level calories nutrition. In our review, we recorded the main hormones and biological markers involved in bone metabolism during pregnancy and breastfeeding period. Regarding imaging methods, ultrasound and magnetic resonance are useful diagnostic tools and MRI can be used as a gold standard when examining hip pain in women who are in the third trimester of pregnancy. Available therapeutic approaches are recorded regarding conservative management and use of medication. The implication of our work is to emphasize the importance of early identification of gestational osteoporosis. Medical specialties dealing with women during pregnancy and postpartum (obstetricians, endocrinologists, orthopedists) should assess the risk factors and be able to make the right diagnosis as early as possible for prognosis optimization.

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“…This inhibition leads to suppression of bone turnover in patients with osteolytic bone disease, and a curative effect has been reported in postmenopausal women. 20 The first report of denosumab for treatment of PO was published in 2016 by Sa´nchez et al, 21 who described two patients treated with bisphosphonates and denosumab. To date, 10 patients with PO who were treated with denosumab, including the patient in the present case, can be found in the English-language literature (Table 3).…”

Section: Case Presentationmentioning

confidence: 99%

“…After two injections, the lumbar spine BMD had increased by 14%. 21 Another patient was treated with TPT and denosumab, and their BMD had significantly increased at 6 months. However, the patient requested an alternative treatment to avoid the frequent injections; therefore, the TPT was switched to subcutaneous injection of denosumab.…”

Section: Case Presentationmentioning

confidence: 99%

Response of vertebral fractures to treatment with denosumab in a patient with postpartum osteoporosis: a case report and literature review

et al. 2023

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Postpartum osteoporosis (PO) is a rare condition characterized by low bone mineral density (BMD) and an increased risk of vertebral fragility fracture. We encountered a 34-year-old woman who developed back pain 1 week after delivery. Magnetic resonance imaging of the lumbar spine revealed three vertebral compression fractures. Pretreatment BMD evaluation by dual-energy X-ray absorptiometry revealed a low T-score and Z-score (−2.0 and −2.0, respectively; BMD, 0.876 g/cm2) in the affected region of the spine. The patient was diagnosed with PO and treated with subcutaneous injection of denosumab 60 mg (Prolia; Amgen, Inc., Thousand Oaks, CA, USA) every 6 months. After two treatments, the BMD had significantly increased and the back pain was improved; the patient therefore decided to terminate the treatment. Two months later, her back pain worsened and BMD decreased as measured by dual-energy X-ray absorptiometry examination of the lumbar spine. Therefore, the patient resumed treatment with denosumab, and the BMD of the lumbar spine increased after another two treatments. Therefore, we consider denosumab to be promising in the management of PO with respect to increased BMD and decreased pain.

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Two cases of pregnancy- and lactation-associated osteoporosis successfully treated with denosumab

Cited by 4 publications

References 6 publications

Impaired bone microarchitecture and strength in patients with tumor-induced osteomalacia

Impaired bone microarchitecture and strength in patients with tumor-induced osteomalacia

Gestational osteoporosis: Myth or true?

Response of vertebral fractures to treatment with denosumab in a patient with postpartum osteoporosis: a case report and literature review

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