Different Treatment Strategies in Pregnancy- and Lactation-Associated Osteoporosis: Three Cases Reports

Presentation Number: SAT 333
Date of Presentation: April 1st, 2017

Anna Kornete1, Ingvars Rasa*2, Maija Mukane3 and Elizabete Kadakovska4
1Riga Stradins University, Riga, Latvia, 2Riga East Clinical University Hospital; Riga Stradins University; Latvian Diabetes Association, Riga, Latvia, 3Riga East Clinical University Hospital; Riga Stradins University; Latvian Osteoporosis and Bone Metabolism Diseases Association, Riga, Latvia, 4MFD; Latvian Osteoporosis and Bone Metabolism Diseases Association, Riga, Latvia

Abstract

Background: Pregnancy- and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis characterized by significant changes in calcium and bone metabolism, resulting in musculoskeletal pain syndrome, fragile bones and increased risk of fractures during late pregnancy and early postpartum period. The etiology and pathogenesis remain incomprehensible, hence there is no mutually agreed opinion on the management of this condition. Three clinical cases of PLO present patients with multiple severe osteoporotic fractures during peri-pregnancy period and different treatment strategies.

Clinical cases: We came across a case of a 34-year-old primiparous woman who had severe lower back pain that worsened two months after a Cesarean delivery. Computed tomography revealed multiple vertebral osteoporotic fractures of the thoracic (Th11, Th12) and lumbar (L1, L2) spine. The lumbar spine bone mineral density (BMD) was below the expected range of age (–2.7 SD). The patient had serum 25-hydroxyvitamin D (25(OH)D) deficiency (11.5 ng/mL). Biochemical markers of bone turnover were increased (serum osteocalcin level – 52.8 ng/ml and serum C-terminal cross-linking telopeptide of type I collagen (𝛽 CTX) level – 0.766 ng/mL). We also encountered a 29-year-old patient with musculoskeletal pain syndrome began in the third trimester of pregnancy and deteriorated immediately postpartum. Magnetic resonance imaging (MRI) showed vertebral compressions of the thoracic (Th11, Th12) and lumbar (L1) spine, osteoporotic fracture of the L2 vertebra. The lumbar spine BMD was below the expected range of age (–4.5 SD). 25(OH)D vitamin level was slightly decreased (21.6 ng/mL), while osteocalcin level and 𝛽 CTX level was increased 56.6 ng/ml and 0.759 ng/ml, respectively. Finally, we report a case of a 35-years-old patient with complaints of progressive unilateral pain in the back, hip and lower extremity, accompanied by reduced general mobility. MRI revealed multiple sacral and femoral osteoporotic fractures. The lumbar spine and femoral BMD was below the expected range of age (–3.9 SD, –3.6 SD, –2.8 SD, respectively). The laboratory assessments (including the 25(OH)D vitamin, osteocalcin, 𝛽 CTX) showed no abnormality. Peripheral blood examination unveiled normal calcium and parathormone level in all the cases. In case 1 daily injection of teriparatide for 10 months was used. In case 2 once-yearly infusion of zoledronic acid and L2 vertebroplasty was performed. In case 3 ibandronic acid injection every three months for two times was conducted.

Conclusion: PLO must be kept in mind in the differential diagnosis in patients presenting with musculoskeletal pain syndrome during peri-pregnancy period. Different treatment strategies may help to reach targets of the therapy in cases of PLO: increase BMD, prevent chronic pain and new fractures and improve the quality of life.

 

Nothing to Disclose: AK, IR, MM, EK