Four-Year Follow-Up of Pregnancy-Associated Osteoporosis: A Case Report

Takahashi, Naoto; Arai, Iwao; Kayama, Satoru; Ichiji, Kenji; Fukuda, Hironari; Handa, Junichi; Konno, Satoshi

doi:10.5387/fms.2014-14

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…A new method (as yet without a current standardized approach) might be represented by the use of blood and/or urinary BTMs. In cases where these are very high, they could be helpful to indicate PAO/LAO in patients with spontaneous fractures, or they should be considered during treatment against osteoporosis [126]. This approach was used amid the COVID-19 pandemic in patients with osteoporosis and associated fractures that were not able to receive medical care in person due to regulations [127].…”

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

confidence: 99%

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/laomentioning

confidence: 99%

Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis

Cârșote

Turturea²,

Valea

et al. 2023

Diagnostics

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show abstract

Effective strategies for pregnancy and lactation-associated osteoporosis: teriparatide use in focus

Ali,

Khan,

Brandi

2024

Endocrine

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Pregnancy- and lactation-associated osteoporosis with vertebral fractures: a systematic review

Qian

Wang²,

Yu³

et al. 2021

BMC Musculoskelet Disord

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Background To review, analyze and characterize the pregnancy and lactation-related osteoporosis (PLO) with vertebral fractures based on the extraction data in the previous studies. Methods A comprehensive literature search of electronic databases including the PubMed, Embase and Web of Science was conducted from January 1st,1990 to December 1st, 2020. The enrolled data were pooled to analyze the baseline characteristics, clinical features, risk factors and treatment options. Results A total of 65 articles with 338 cases were enrolled for data extraction. The enrolled cases aged from 19 to 47 years, with a mean value of 35.7 years old. The average body mass index (BMI) was 22.2 kg/m2 ranged from 16.0 to 39.0 kg/m2. Of the 173 cases, 149 cases with vertebral fractures occurred in the first pregnancy, 19 cases in the second pregnancy, four cases in the third pregnancy and one case in the fourth pregnancy. Up to 91.5% of the back pain occurred within the last 3 months of pregnancy and the first 3 months after delivery. The most involved vertebral levels were L2, L1 and T12 accounting for 32.6% of all the fractures. The average fracture numbers were 4.4 levels per patient. The lumbar Z-scores were mostly recorded with a mean value of − 3.2 ranged from − 7.8 to 0. Conclusions PLO with vertebral fractures is a rare clinical entity, which is more likely to occur in older and thinner pregnant women. Back pain is the clinical complaint and mostly occurs in the late pregnancy and early lactation periods. Most vertebral fractures appear in the first pregnancy but it can occur in any time of pregnancy. Thoracolumbar region is the mostly involved region. As compared with postmenopausal osteoporotic fractures, PLO usually has multiple levels fractures. Bisphosphonates are the most widely used treatment so far, however, many factors need to be taken into account to decide which drug to choose in PLO and further studies are necessary for clear recommendation in the future.

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Four-Year Follow-Up of Pregnancy-Associated Osteoporosis: A Case Report

Cited by 4 publications

References 15 publications

Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis

Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis

Effective strategies for pregnancy and lactation-associated osteoporosis: teriparatide use in focus

Pregnancy- and lactation-associated osteoporosis with vertebral fractures: a systematic review

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