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

Abstract

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.

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

“…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.…”

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

“…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).…”

Women With Pregnancy and Lactation–Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level

“…(20,21) BMD before pregnancy is usually not available because there would have been no indication to measure it. BMD by DXA at presentation is generally extremely low, (13,(16)(17)(18)(19)(22)(23)(24)(25)(26)(27)(28)(29) with reported Z-scores often below -3.0. Because of the rarity of this condition, very little is known about the pathophysiology of PLO, its natural history and risk factors, and how best to treat it.…”