Severe Bone Microarchitecture Impairment in Women With Pregnancy and Lactation-Associated Osteoporosis

Abstract

Context Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition characterized by fragility fractures, mostly vertebral, during the third trimester of pregnancy or the early postpartum. Objective The aim of this study was to evaluate bone microarchitecture in women with PLO in order to better understand the pathophysiology of this disease. Design and methods In this retrospective study, we included women with PLO referred to our bone center between November 2007 and July 2012. We assessed bone mineral density (BMD) by DXA, bone turnover markers and bone microarchitecture by HR-pQCT. Results were compared with a control group of healthy lactating women. Results Among the seven primiparous patients with PLO, six suffered vertebral fractures and one developed a hip fracture during the seventh month of gestation. Fractures occurred within the eighth month of pregnancy and the fourth month of postpartum; vertebral fractures were multiple in 85.7%. Major or minor risk factors for osteoporosis were present in 86% of our patients. Trabecular density, number and thickness were 34%, 20% and 22% lower than controls, (p < 0.01, p = 0.01 and p = 0.01, respectively). Cortical parameters were also deteriorated but to a lesser extent. Conclusion In comparison with healthy lactating women, patients with PLO presented severe deterioration of bone trabecular and cortical microarchitecture. This significant compromise may explain the occurrence of multiple fractures in these otherwise healthy young women. Further prospective studies are needed in order to determine whether bone microarchitecture might be able to be restored in the future.

Bone Microarchitecture and Strength Changes During Teriparatide and Zoledronic Acid Treatment in a Patient with Pregnancy and Lactation-Associated Osteoporosis with Multiple Vertebral Fractures

“…In line with previous studies [ 7 , 8 , 10 , 11 ], the trabecular bone was more affected than the cortical bone but recovered earlier. At 7 months postpartum, aBMD T -score was worse at the lumbar spine (predominantly trabecular) than at the total hip (cortical and trabecular), and trabecular BMD was relatively lower than cortical BMD at the distal radius and tibia.…”

“…Additionally, they may experience a decrease in volumetric BMD and changes in bone microarchitecture at the distal tibia and proximal radius [ 8 , 9 ]. In PLO, bone loss is aggravated, and impaired volumetric BMD and bone microarchitecture have been reported compared to healthy controls [ 10 ] and healthy lactating women [ 11 ]. The woman in this report also had a severely impaired aBMD, volumetric BMD, and bone microarchitecture compared to healthy controls, which even after treatment persisted until 40 months postpartum.…”

Osteoporosis in premenopausal women

“…Denná doporučená dávka vitamínu D je minimálne 600 IU, v prípade deficitu vitamínu D dávka 150-2 000 IU (55). Suplementácia kalcia však u postpartálnych zdravých žien neviedla v porovnaní s placebom k prevencii straty kostnej denzity počas laktácie a bola asociovaná iba s miernym vzostupom kostnej denzity po ukončení dojčenia (56,57). Tehotenstvo a laktácia sú asociované s poklesom v kostnej denzite hlavne trabekulárnej kosti, ktorý sa napraví zvyčajne do 6-12 mesiacov po skončení dojčenia.…”

Recent Insights into Pregnancy and Lactation-Associated Osteoporosis (PLO)

“…We studied a group of seven women with PLO and only two of them had major risk factors for osteoporosis (high doses of glucocorticoids and kidney stones with hypercalciuria). 25 In the rest, it was our impression that the severity of risk factors (low calcium intake, family history of osteoporosis, smoking) was not enough to account for the occurrence of vertebral fractures in these premenopausal women. We also observed a trend towards a lower BMI in our patients with PLO, who had a mean BMI of 20.9 ± 1.9 kg/m2 vs 22.3 ± 2.6 kg/m2 in controls, as other authors have already described.…”