Post‐pregnancy osteoporosis associated with hypercalcaemia

Abstract

A lactating 31-year-old woman who developed four vertebral fractures 1-2 months after the delivery of her first child is described. She was hypercalcaemic (serum calcium up to 2.99 mmol/l), and urinary excretion of both calcium and hydroxyproline (an index of bone resorption) were markedly elevated. Serum levels of parathyroid hormone and 1,25-dihydroxyvitamin D were suppressed, but parathyroid hormone-related peptide was above normal. There was severe axial osteopenia, as assessed by dual-energy X-ray absorptiometry. The biochemical abnormalities were reversed within 2 weeks of weaning, with the exception of the parathyroid hormone-related peptide concentration, which declined more gradually. This appears to be the first description of the abnormalities in calcium metabolism and bone density from early in the course of post-pregnancy osteoporosis and it indicates that this condition is associated with high levels of osteolysis which return to normal after weaning. This rapid reversal of the metabolic abnormalities accounts for the inconclusive nature of previous descriptions of post-pregnancy osteoporosis, in which investigations were more delayed. It also emphasizes the importance of weaning in the management of women presenting with this condition. A possible aetiological role for parathyroid hormone-related peptide is discussed.

Hypercalcemia during Pregnancy, Puerperium, and Lactation: Review and a Case Report of Hypercalcemic Crisis after Delivery Due to Excessive Production of PTH-related Protein (PTHrP) without Malignancy (Humoral Hypercalcemia of Pregnancy)

“…Similarly, hypercalcemia with a slightly elevated serum level of PTHrP (1.12-2.21 pmol/L) has been reported in several women during lactation [14,[37][38][39]. Lactating women frequently have postpartum osteoporosis, and an increased serum level of PTHrP has also been reported in a hypercalcemic patient [37].…”

“…Lactating women frequently have postpartum osteoporosis, and an increased serum level of PTHrP has also been reported in a hypercalcemic patient [37]. Usually, the hypercalcemia is mild, self-limiting, and resolves gradually after weaning [37][38][39].…”

Percutaneous Vertebroplasty for Pregnancy-Associated Osteoporotic Vertebral Compression Fractures

“…Reid et al 10) suggest PTHrP is deeply associated with the development of pregnancy-associated osteoporosis. During lactation, the regulation of bone loss probably involves several factors : calcium lost in breast milk, the hypoestrogenic state and the increased levels of PTHrP that are in circulation 1,10) . The bone absorption increases with the decreased bone density.…”

Gebelik ile ilişkili Osteoporoz

“…Ağrı bazı olgularda gürültülü seyredip hastaların günlük işlerini kısıtlayacak hatta bebeğini kucağına almasına engel olacak düzeyde şiddetli olabilir. Bazı olgularda hiperkalseminin eşlik ettiği gösterilmiş ise de genellikle hafif yükselmiş ALP değerleri dışında bir laboratuvar anormallik gözlenmez (26,27). Bu hastalarda erken tanı konması ve tedaviye hemen başlanması KMY'de artış sağlamak, hastayı oluşabilecek kırıklardan korumak ve ağrının kronikleşmesini önlemek açısından önemlidir.…”

“…(43)'nın yaptığı çalışmada 10 yılı aşkın gözlemde pediatrik yaş grubunda osteoporoz tedavisinde bifosfonatlar kullanılmış ve yan etki görülmediği bildirilmiştir. Bifosfonatlardan hem etidronat disodyum 400 mg hem de pamidronat 30 mg kullanımının KMY'de artış sağladığı değişik çalışmalarda gösterilmiştir (44,45). O'Sullivan ve ark.…”