Pregnancy- and Lactation-Associated Osteoporotic Vertebral Fracture: A Case Report

Jadhav, Aarti; Jadhav, Shalik; Varma, Anuj

doi:10.7759/cureus.31322

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…However, a low BMD is generally expected; previous reports showed a mean DXA Z-score of −3.2 SD (lowest value of −7.8 SD) [74]. We found Z-score values varying from −2.2 SD to −4 SD [23,44,51,59,60,62,65].…”

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

confidence: 39%

“…LAO, as indicated by the clinical and imaging assessment, was treated by stopping lactation (via bromocriptine use), oral cholecalciferol (6000 UI/day), calcium, and alendronate (70 mg/week). Check-up at 4 months showed a good outcome [59].…”

Section: Case Reports Of Laomentioning

confidence: 86%

“…Overall, in addition to 24 new (single) case reports [23,44,51,[55][56][57][58][59][60][61][62][63][64][65][66][67][68], we identified 12 original studies (with at least 6 patients with PAO/LAO per study): 1 study was published in 2023 (within the first 3 months of the year), 5 were published in 2022, and 6 in 2021. Except for one survey [43], these were retrospective cohorts (one being a nationwide study in Japan) [41].…”

Section: Discussionmentioning

confidence: 99%

“…Case reports (one patient per study) concerning PAO/LAO displayed starting with (please see references[23,44,51,[55][56][57][58][59][60][61][62][63][64][65][66][67][68]). …”

mentioning

confidence: 99%

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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/laosupporting

confidence: 39%

Section: Case Reports Of Laomentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

“…Case reports (one patient per study) concerning PAO/LAO displayed starting with (please see references[23,44,51,[55][56][57][58][59][60][61][62][63][64][65][66][67][68]). …”

mentioning

confidence: 99%

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Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis

Cârșote

Turturea²,

Valea

et al. 2023

Diagnostics

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“…Vitamin D (VD) deficiency is associated with GDM, miscarriage, and stillbirth [ 126 ]. Calcium deficiency is associated with PE [ 127 ] and pregnancy lactation-associated osteoporosis [ 128 ]. Moreover, dietary lipid intakes, such as n-3 polyunsaturated fatty acids (PUFAs) and long-chain polyunsaturated fatty acids (LCPUFAs), are indispensable in utero for the growing fetal brain and neurodevelopment [ 129 , 130 ].…”

Section: Influence Of Environmental Factors On Fabp4 During Pregnancymentioning

confidence: 99%

Pathophysiological Insight into Fatty Acid-Binding Protein-4: Multifaced Roles in Reproduction, Pregnancy, and Offspring Health

Shi

Wang

et al. 2023

IJMS

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Fatty acid-binding protein-4 (FABP4), commonly known as adipocyte-fatty acid-binding protein (A-FABP), is a pleiotropic adipokine that broadly affects immunity and metabolism. It has been increasingly recognized that FABP4 dysfunction is associated with various metabolic syndromes, including obesity, diabetes, cardiovascular diseases, and metabolic inflammation. However, its explicit roles within the context of women’s reproduction and pregnancy remain to be investigated. In this review, we collate recent studies probing the influence of FABP4 on female reproduction, pregnancy, and even fetal health. Elevated circulating FABP4 levels have been found to correlate with impaired reproductive function in women, such as polycystic ovary syndrome and endometriosis. Throughout pregnancy, FABP4 affects maternal–fetal interface homeostasis by affecting both glycolipid metabolism and immune tolerance, leading to adverse pregnancy outcomes, including miscarriage, gestational obesity, gestational diabetes, and preeclampsia. Moreover, maternal FABP4 levels exhibit a substantial linkage with the metabolic health of offspring. Herein, we discuss the emerging significance and potential application of FABP4 in reproduction and pregnancy health and delve into its underlying mechanism at molecular levels.

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