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

CONTEXT: Teriparatide (TPTD) therapy has been proposed as a potential treatment strategy in severe cases of pregnancy- and lactation-associated osteoporosis (PLO) characterized by the occurrence of fragility fractures in the third trimester or early postpartum. OBJECTIVE: To investigate the changes in bone mineral density (BMD) and bone turnover markers in patients with PLO with and without TPTD treatment. DESIGN: Retrospective cohort study. PATIENTS: Thirty-two patients with PLO who presented with multiple vertebral fractures to a tertiary institution between 2007 and 2015 were included. MEASUREMENTS: Changes in BMD at the lumbar spine (LSBMD) and proximal femur after 12 months of daily subcutaneous injections of 20 µg TPTD (n = 27) were assessed. Subjects who rejected the TPTD treatment were used as controls (n = 5). RESULTS: LSBMD increased in both subjects treated with TPTD and controls, with greater increases in the TPTD group (15.5 ± 6.6% vs 7.5 ± 7.1%, P = .020) after adjustment for age and baseline LSBMD. During follow-up, serum levels of osteocalcin (OCN) and C-telopeptide of type I collagen (CTX) increased significantly in the TPTD group. In multivariate linear regression models, TPTD treatment (adjusted ß = 7.92, P = .032) and younger age (adjusted ß = 1.06, P = .046), but not baseline LSBMD, body mass index, serum OCN level and CTX level, were independently associated with greater increases in LSBMD. CONCLUSIONS: In patients with PLO, LSBMD at 12 months increased in both the TPTD-treated and control groups. TPTD treatment and younger age were associated with greater increases in LSMBD irrespective of baseline LSBMD.

Mutational analysis uncovers monogenic bone disorders in women with pregnancy-associated osteoporosis: three novel mutations in LRP5, COL1A1, and COL1A2.

Pregnancy was found to be a skeletal risk factor promoting the initial onset of previously unrecognized monogenic bone disorders, thus explaining a proportion of cases with pregnancy-associated osteoporosis. Therapeutic measures should focus in particular on the normalization of the disturbed calcium homeostasis in order to enable the partial skeletal recovery. INTRODUCTION: Pregnancy-associated osteoporosis (PAO) is a rare skeletal condition, which is characterized by a reduction in bone mineral density (BMD) in the course of pregnancy and lactation. Typical symptoms include vertebral compression fractures and transient osteoporosis of the hip. Since the etiology is not well understood, this prospective study was conducted in order to elucidate the relevance of pathogenic gene variants for the development of PAO. METHODS: Seven consecutive cases with the diagnosis of PAO underwent a skeletal assessment (blood tests, DXA, HR-pQCT) and a comprehensive genetic analysis using a custom-designed gene panel. RESULTS: All cases showed a reduced BMD (DXA T-score, lumbar spine - 3.2 ± 1.0; left femur - 2.2 ± 0.5; right femur - 1.9 ± 0.5), while the spine was affected more severely (p < 0.05). The trabecular and cortical thickness was overall reduced in HR-pQCT, while the trabecular number showed no alterations in most cases. The genetic analysis revealed three novel mutations in LRP5, COL1A1, and COL1A2. CONCLUSION: Our data show that previously unrecognized monogenic bone disorders play an important role in PAO. Pregnancy should be considered a skeletal risk factor, which can promote the initial clinical onset of such skeletal disorders. The underlying increased calcium demand is essential in terms of prophylactic and therapeutic measures, which are especially required in individuals with a genetically determined low bone mass. The implementation of this knowledge in clinical practice can enable the partial recovery of the skeleton. Consistent genetic studies are needed to analyze the frequency of pathogenic variants in women with PAO.

Successful neridronate therapy in pregnancy-associated osteoporosis.

Pregnancy-associated osteoporosis is a rare condition. The pathogenesis is probably multifactorial but has not yet been completely clarified. In this case report, a 38-year-old woman was referred to hospital after suffering an acute, non-traumatic back pain one month after delivering her first child. The radiological examination revealed four vertebral fractures. Bone mineral density was reduced, particularly at spine level. Biochemical tests were within normal range, except for increased urinary deoxypyridinoline and a slight reduction of the serum 25-OH vitamin D level. The patient was treated with neridronate, calcium and cholecalciferol. After one month, the patient was free of pain and DXA measurement after six months showed a marked recovery of bone mineral density at the spine and hip level.

Pregnancy-associated osteoporosis with seven vertebral compression fractures, a case treated with strontium ranelate.

This paper shows a case of pregnancy-associated osteoporosis (PAO) with seven vertebral compression fractures treated with strontium ranelate and supplementation of calcium and cholecalciferol. Clinical evaluation, laboratory and radiological results are analyzed in the case-report to demonstrate that strontium ranelate is a good option to restore quickly the value of bone mineral density in the treatment of a case of PAO.

Pregnancy-associated osteoporosis following in vitro fertilization: A case report.

This case report illustrates that in vitro fertilization (IVF) may be a potential risk factor for pregnancy-associated osteoporosis (PAO), highlighting the need for awareness and monitoring of bone health in women undergoing IVF treatments. PAO is a rare disease resulting from an imbalance of calcium in the body during pregnancy and lactation and presenting with fragility fractures. PAO occurs in late pregnancy or early postpartum period. A 28-year-old woman who conceived through IVF experienced severe back pain 2 days after delivery. Magnetic resonance imaging of the spine showed wedge-shaped fractures of T9-T12 vertebrae. Bone mineral density (BMD) was low on dual-energy x-ray absorptiometry. The laboratory tests were within the normal range. Based on the clinical manifestations, osteoporotic spine fracture, results of BMD, and exclusion of other causes of osteoporosis, the patient was diagnosed with PAO. Considering the deleterious effect of treatment with gonadotropin-releasing hormone and repeated superovulation on bone, we hypothesized that IVF may be an etiological factor for PAO.

The experience of pregnancy associated osteoporosis: An international survey with implications for midwifery care.

INTRODUCTION: Pregnancy associated osteoporosis (PAO) is a rare and complex condition. Its etiology is unclear, but possible predisposing factors include osteoporosis in a first degree relative, low body mass index, celiac or other malabsorption disorders, poor nutrition, low vitamin D and calcium intake, long-term use of medications associated with bone loss, physical inactivity, and prolonged amenorrhea. There is no standard for diagnosis or treatment. Diagnosis is typically made following reports of severe pain and imaging establishing the presence of fractures in vertebrae, pelvic structures, or the femoral neck. Research has focused on diagnosis and effective treatments. The absence of descriptive statistics and qualitative data about the presentation, recovery, and psychosocial dimensions of PAO represents a striking gap in the existing literature. The objectives for this preliminary study were to identify key features and the range of experiences of individuals with PAO to aid midwives, who are uniquely situated to identify the condition early in the postpartum course, and to inform future midwifery research on supporting recovery from this complex condition. METHODS: A 39-47 question survey was developed in Qualtrics; questions were primarily quantitative. Members (N = 306) of a closed, international Osteoporosis and Pregnancy Facebook group were recruited with a post announcing the study and a link to the survey, followed by 2 reminders between June and August 2020. Data were analyzed in Qualtrics. Descriptive statistics were compiled. Qualitative data were analyzed using a grounded theory approach with both open and selective coding. FINDINGS: Sixty-nine individuals (22% response rate) representing 12 countries responded to the survey, with most respondents from the United States, the United Kingdom, and Australia. Respondents frequently reported delays in diagnosis; only 4.4% of respondents were diagnosed within one month of the onset of fracture pain. Cessation of breastfeeding to reverse physiologic hypoestrogenemia and to stop calcium loss, dietary supplementation, orthopedic braces, and osteoanabolic medications or parathyroid hormone analogues were commonly reported treatment approaches. PAO has a prolonged impact on mobility and infant care. Six months from the onset of fracture pain, only 42% of respondents were physically able to care for their infants alone. CONCLUSION: PAO is a rare and complex condition in need of further research. Dismissal of pain and lack of knowledge about PAO are frequently encountered by those seeking care, which midwives may be able to mitigate with timely referrals to appropriate specialists. PAO often has a prolonged impact on the ability to care for an infant alone. This should be considered in the development of comprehensive care plans. The core competencies of the International Confederation of Midwives include assessing health status and screening for risks, facilitating individualized decision-making about care, and recognizing conditions outside midwifery scope of practice and referring appropriately (ICM 2019). As members of diverse health care teams, midwives may have opportunities to facilitate diagnosis through timely referral, encourage collaborative decision-making on treatment and future perinatal care, and weigh in on the impact of individual social determinants of health.

Pregnancy-associated transient osteoporosis of the hip: results of a case-control study.

The etiology and underlying mechanisms of transient of osteoporosis of the hip (TOH) during pregnancy are still unclear, since no systematic analyses exist. Our results support the hypothesis that TOH is a multifactorial disease, which is associated with immobility, dental problems, and lack of exercise in childhood. INTRODUCTION: Pregnancy-associated transient osteoporosis of the hip (TOH) is a rare but severe form of osteoporosis, which may affect a subgroup of women in the last trimester of pregnancy or immediately postpartum. Common symptoms include acute pain of the hip(s) due to bone marrow edema or even hip fractures. The exact underlining mechanisms of this disorder are still unknown since no published systematic analyses exist. METHODS: Out of a total of 52 TOH patients, 33 TOH patients could be matched with 33 healthy controls according to age, region, and gravity. The aim of this retrospective case-control study was to evaluate the risk factors for TOH in a homogenous population of women. RESULTS: The baseline characteristics of the two study groups were similar. Overall, 12.1% of the TOH patients sustained a hip fracture. Expectedly, 90.9% of the TOH patients complained about pain of the hip (p ≤ 0.001). TOH patients suffered more frequently from severe dental problems during childhood (p = 0.023) and performed less often sports before and after puberty (p ≤ 0.001), whereas the frequency of immobilization during pregnancy was threefold higher compared to the control group (p = 0.007). We found a significant increase of the TOH risk in patients with dental problems in childhood (OR 3.7; CI 1.3-10.7) as well as in patients with lack of exercise during childhood (OR 4.2; CI 1.3-12.9). CONCLUSIONS: Our results support the hypothesis that pregnancy-associated TOH is a multifactorial disease, to which several individual factors may contribute. Hereby, we found significant associations with immobility, dental problems, and lack of exercise in childhood.

Spinal compression fractures due to pregnancy-associated osteoporosis.

OBJECTIVES: To report on unique cases of spinal compression fractures due to pregnancy-associated osteoporosis (PAO) and to suggest a satisfactory treatment modality. MATERIALS AND METHODS: A single-center retrospective study. We reviewed the data of 535 patients with osteoporotic spinal compression fractures over a period of 5-year. Two patients who developed spinal compression fractures due to PAO were identified and treated. RESULTS: The clinical presentation and blood investigations ruled out other causes of osteoporosis. Dual-energy X-ray absorptiometry was used to confirm the diagnosis. All patients improved with medical management. CONCLUSION: Vertebral fractures due to PAO should be considered as a differential diagnosis in patients with back pain who are in the third trimester of pregnancy or in postpartum. Early recognition and appropriate conservative management would be necessary to prevent complications such as new vertebral fractures and chronic back pain.

Percutaneous vertebroplasty for pregnancy-associated osteoporotic vertebral compression fractures.

Osteoporosis is a worldwide problem and it mainly affects postmenopausal women. Osteoporosis associated with pregnancy or lactation is a rare condition. The incidence and mechanism of this phenomenon has not been clarified, but it can cause one or more vertebral compression fractures with severe, prolonged back pain in the affected women. We experienced this uncommon case, treated it with percutaneous vertebroplasty. A 35-old-woman visited our hospital with complaints of severe back pain and flank pain 2 months after normal vaginal delivery. She was diagnosed with osteoporotic vertebral compression fractures on the T5, 8, 9 and 11 vertebral bodies and we performed percutaneous vertebroplasty on the T8, 9 and 11 vertebrae with a good result. We present here an unusual case of pregnancy-associated compression fractures treated by percutaneous vertebroplasty.

Percutaneous Vertebroplasty for Pregnancy-Associated Osteoporotic Vertebral Compression Fractures

Osteoporosis is a worldwide problem and it mainly affects postmenopausal women. Osteoporosis associated with pregnancy or lactation is a rare condition. The incidence and mechanism of this phenomenon has not been clarified, but it can cause one or more vertebral compression fractures with severe, prolonged back pain in the affected women. We experienced this uncommon case, treated it with percutaneous vertebroplasty. A 35-old-woman visited our hospital with complaints of severe back pain and flank pain 2 months after normal vaginal delivery. She was diagnosed with osteoporotic vertebral compression fractures on the T5, 8, 9 and 11 vertebral bodies and we performed percutaneous vertebroplasty on the T8, 9 and 11 vertebrae with a good result. We present here an unusual case of pregnancy-associated compression fractures treated by percutaneous vertebroplasty.

A case of postpregnancy spinal osteoporosis / 대한내과학회지

Osteoporosis associated with pregnancy is rare, but it is accompanied by a substantial bone loss, resulting in fracture by minimal trauma. Nevertheless, this clinical significance is often ignored because the pain in various parts of the body is taken as an integral part of the pregnancy and it is possible that milder forms of this condition go unnoticed. Also, this disease is often confused with a variety of other condition associated with pregnancy and misdiagnosed. Although its etiology is still unknown, but variant theory is speculated. Pregnancy and lactation increase the demand on the maternal skeletal calcium restores and underlying genetic susceptibility may cause it. Recently it has been proposed that PTH-related protein may be an important causative factor. There are three types of the pregnancy associated osteoporosis, a transient osteoporosis of the hip in pregnancy, a postpregnancy spinal osteoporosis and a lactation-associated osteoporosis. We present a case of 24-years old women with postpregnancy spinal osteoporosis that showed multiple lumbar compression fracture and biochemical evidence of increased bone resorption.

A Case of Postpregnancy Spinal Osteoporosis / 대한내분비학회지

Osteoporosis is a common disease of the elderly and occurs especially in the postmenopausal women. Rarely, it occurs during a pregnancy or shortly thereafter and is accompanied by a substantial bone loss, resulting in fractures. The clinical significance of pregnancy-associated osteoporosis has been noted since the 1950s. Although its etiology is still unknown, it has recently been proposed that PTHrP may be an important causative factor in pregnancy-associated osteoporosis. There are three types of the pregnancy-associated osteoporosis, (1) a transient osteoporosis of the hip pregnancy, (2) a postpregnancy spinal osteoporosis and (3) a lactation-associated osteoporosis. Postpregnancy spinal osteoporosis typically occurs within three months after a first delivery and usually involving the axial skeleton accompanied by back pain, bone loss and a fracture. We present a case of postpregnancy spinal osteoporosis that developed three months after a first delivery. Our patient also showed multiple compression fractures in her lumbar spine and biochemical evidence of increased bone resorption.