Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up

Kyvernitakis, I; Reuter, TC; Hellmeyer, L; Hars, O; Hadji, Peyman

doi:10.1007/s00198-017-4239-1

Cited by 66 publications

(72 citation statements)

References 27 publications

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“…(11,(15)(16)(17)(18)(19) In two cohort studies (n = 35 and n = 107), (20,21) over 80% had no known cause, (20) 70% were primiparous, (20,21) and 89% to 93% presented with vertebral fractures. (20,21) BMD before pregnancy is usually not available because there would have been no indication to measure it. BMD by DXA at presentation is generally extremely low, (13,(16)(17)(18)(19)(22)(23)(24)(25)(26)(27)(28)(29) with reported Z-scores often below -3.0.…”

Section: Introductionmentioning

confidence: 99%

“…Most women are otherwise healthy, with no known condition that would predispose them to fractures. (11,(15)(16)(17)(18)(19) In two cohort studies (n = 35 and n = 107), (20,21) over 80% had no known cause, (20) 70% were primiparous, (20,21) and 89% to 93% presented with vertebral fractures. (20,21) BMD before pregnancy is usually not available because there would have been no indication to measure it.…”

Section: Introductionmentioning

confidence: 99%

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Women With Pregnancy and Lactation–Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level

Cohen

Kamanda‐Kosseh

Dempster

et al. 2019

Journal of Bone and Mineral Research

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Pregnancy and lactation–associated osteoporosis (PLO) is a rare, severe, early form of osteoporosis in which young women present with fractures, usually multiple vertebral fractures, during late pregnancy or lactation. In studies of idiopathic osteoporosis (IOP) in premenopausal women, we enrolled 78 women with low‐trauma fractures and 40 healthy controls, all with normal menses and no secondary cause of bone loss. In 15 of the affected women, the PLO subgroup, fractures had occurred during late pregnancy or lactation. We hypothesized that clinical, bone structural, and metabolic characteristics would differ between women with PLO and those with (non‐PLO) IOP and controls. All were evaluated > 12 months postpartum, when structural and remodeling characteristics would be expected to reflect baseline premenopausal status rather than transient postpartum changes. As previously reported, affected subjects (PLO and IOP) had BMD and microarchitectural deficiencies compared to controls. Women with PLO did not differ from those with IOP in terms of age, BMI, body fat, menarcheal age, parity, or age at first pregnancy. However, women with PLO had a more severe clinical presentation than those with IOP: more fractures (5.5 ± 3.3 versus 2.6 ± 2.1; p = 0.005); more vertebral fractures (80% versus 17%; p < 0.001); and higher prevalence of multiple fractures. BMD deficits were more profound and cortical width tended to be lower in PLO. PLO subjects also had significantly lower tissue‐level mineral apposition rate and bone formation rates (0.005 ± 0.005 versus 0.011 ± 0.010 mm2/mm/year; p = 0.006), as well as lower serum P1NP (33 ± 12 versus 44 ± 18 µg/L; p = 0.02) and CTX (257 ± 102 versus 355 ± 193 pg/mL; p = 0.01) than IOP. The finding that women with PLO have a low bone remodeling state assessed more than a year postpartum increases our understanding of the pathogenic mechanism of PLO. We conclude that women with PLO may have underlying osteoblast functional deficits which could affect their therapeutic response to osteoanabolic medications. © 2019 American Society for Bone and Mineral Research.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Women With Pregnancy and Lactation–Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level

Cohen

Kamanda‐Kosseh

Dempster

et al. 2019

Journal of Bone and Mineral Research

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“…However, multiple vertebral fractures may lead to severe back pain and height loss, reducing the quality of life, and result in a residual risk of subsequent fracture, which might require medical intervention . Furthermore, a recent large cohort study reported that 24.3% of 107 patients with PLO had one or more subsequent fractures during a median follow‐up of 6 years . The risk was positively correlated with the number of fractures at the time of diagnosis, suggesting that severe PLO carries a substantial risk of fracture, which must be taken into consideration …”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, a recent large cohort study reported that 24.3% of 107 patients with PLO had one or more subsequent fractures during a median follow‐up of 6 years . The risk was positively correlated with the number of fractures at the time of diagnosis, suggesting that severe PLO carries a substantial risk of fracture, which must be taken into consideration …”

Section: Introductionmentioning

confidence: 99%

Changes in bone mineral density and bone turnover markers during treatment with teriparatide in pregnancy‐ and lactation‐associated osteoporosis

Hong

Kim

Lee

et al. 2018

Clinical Endocrinology

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“…In addition, the administration of denosumab can significantly improve patients' symptoms and bone density [12]. Stopping breastfeeding could reduce the loss of calcium, and the longer of the lactation lasting, the more fractures occur on average [13]. Bisphosphonates have a relatively short bone retention time and are highly effective and well tolerated in the treatment of PLO, but they need to be cautious or stop breastfeeding because of their potential harm to the fetus [14,15].…”

Section: Discussionmentioning

confidence: 99%

Challenges in the Management of Pregnancy and Lactation-Associated Osteoporosis (PLO) in Women of Childbearing age With Multiple Vertebral Fractures

Liu¹,

Jiao²,

Li³

2019

ijSciences

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Pregnancy and lactation-associated osteoporosis (PLO) is a rare but serious and difficult to be diagnosed disease, which occurs in the late gestation and early lactation, mainly manifested by low back pain, vertebral fracture and reduction of hip bone density. It is difficult to diagnose and has a high rate of misdiagnosis and mistreatment. We present the case of a 39-year-old woman who suffered from acute low back pain and walking difficulty after a sudden stoop in 2 months postnatal. The X-ray and MRI examination showed that fractures occurred in the first, second and fifth lumbar vertebrae. Bone mineral density (BMD) examination confirmed osteoporosis. After stopping lactation, calcium and vitamin K2 supplemented, compared with zoledronic acid injection, the low back pain was relieved and the BMD increased gradually. The incidence of PLO is seriously underestimated in clinical practice. Women in pregnancy and lactation with acute low back pain should be highly alert to the occurrence of PLO, and early treatment need to be taken in case of further serious consequences such as vertebral compression fracture or hip fracture.

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Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up

Abstract: Almost a quarter of patients with PAO will sustain a subsequent fracture, and this fracture risk correlates with the number of fractures at time of diagnosis. Patients with PAO need to be informed about their potential subsequent fracture risk before deciding for further pregnancies.

Cited by 66 publications

References 27 publications

Women With Pregnancy and Lactation–Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level

Women With Pregnancy and Lactation–Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level

Changes in bone mineral density and bone turnover markers during treatment with teriparatide in pregnancy‐ and lactation‐associated osteoporosis

Challenges in the Management of Pregnancy and Lactation-Associated Osteoporosis (PLO) in Women of Childbearing age With Multiple Vertebral Fractures

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