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

Abstract

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.

Effect of Teriparatide on Subsequent Fracture and Bone Mineral Density in 47 Women with Pregnancy- and Lactation-associated Osteoporosis and Vertebral Fractures

“…This fracture risk correlated with the number of fractures at diagnosis. These findings were recently confirmed in a review by Qian et al 22 and were congruent with other 338 cases from 65 included papers.…”

New Entity—Thalassemic Endocrine Disease: Major Beta-Thalassemia and Endocrine Involvement

“…An individual decision should be taken extremely cautiously by a multidisciplinary team. The complete panel of potential complications that interfere with pregnancy outcome also includes endocrine components from DM for the adequate replacement of hypothyroidism and sufficient VD to maintain bone health [ 164 , 165 , 166 , 167 ]. Prior anti-OP medication has insufficient evidence, but this is not a contra-indication [ 165 , 166 , 167 ].…”

“…The complete panel of potential complications that interfere with pregnancy outcome also includes endocrine components from DM for the adequate replacement of hypothyroidism and sufficient VD to maintain bone health [ 164 , 165 , 166 , 167 ]. Prior anti-OP medication has insufficient evidence, but this is not a contra-indication [ 165 , 166 , 167 ]. Mild EDs such as subclinical hypothyroidism or IFG/IGT might become overt or clinically symptomatic during pregnancy, which is why practitioners should be aware of these issues.…”

Associations between Pregnancy-Related Symptoms, Serum 25(OH)D, and Physical Quality of Life in Pregnant Women

“…The impact of vitamin D deficiency on musculoskeletal pain is important as it can significantly affect quality of life (QOL). In addition, there is evidence that vitamin D deficiency can also be a risk factor for the development of a rare condition in pregnancy known as pregnancy- and lactation-associated osteoporosis (PLO) that often presents with severe hip/back pain [ 11 , 12 , 13 ]. PLO “carries great physiological and psychological burdens to patients and has negative effects on quality of life and working ability” [ 11 , 13 ].…”