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![a Changes in parameters at the woman’s left distal radius from HR-pQCT examinations between 7 and 39 months postpartum that greatly exceeded least-significant changes from literature at 39 months. TPTD is teriparatide, ZA is zoledronic acid, and the dotted grey lines indicate percentile scores from age- and gender-matched normative data [5]. b Three-dimensional visualization of the HR-pQCT scan of the left distal radius at 7 months postpartum. c Axial mid-slice of the left distal radius showing bone gain (green) and loss (pink) between 7 and 39 months postpartum from HR-pQCT examinations](publication/368423663/figure/fig2/AS:11431281148292001@1681696113950/a-Changes-in-parameters-at-the-womans-left-distal-radius-from-HR-pQCT-examinations.png)
a Changes in parameters at the woman’s left distal radius from HR-pQCT examinations between 7 and 39 months postpartum that greatly exceeded least-significant changes from literature at 39 months. TPTD is teriparatide, ZA is zoledronic acid, and the dotted grey lines indicate percentile scores from age- and gender-matched normative data [5]. b Three-dimensional visualization of the HR-pQCT scan of the left distal radius at 7 months postpartum. c Axial mid-slice of the left distal radius showing bone gain (green) and loss (pink) between 7 and 39 months postpartum from HR-pQCT examinations
Source publication
Pregnancy- and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis, of which the pathogenesis and best treatment options are unclear. In this report, we describe the case of a 34-year old woman diagnosed with severe osteoporosis and multiple vertebral fractures after her first pregnancy, who was subsequently treated with teripara...
Similar publications
As the aging population increases, the number of patients with osteoporosis is gradually rising. Osteoporosis is a metabolic bone disease characterized by low bone mass and the microarchitectural deterioration of bone tissue, resulting in reduced bone strength and an increased risk of low-energy or fragility fractures. Thus, the use of anti-resorpt...
Citations
... Some Food and Drug Administration (FDA)-approved drugs that are commonly prescribed are bisphosphonates, teriparatide, and denosumab. Currently, these drugs are prescribed along with calcium and vitamin D supplements for the management of osteoporosis in lactating females (26,27). The present review provides a holistic definition of PLO and discusses the likely mechanism involved in its onset, systematic investigations, and diagnostic tools with a brief discussion on the management of the disease. ...
Bu derlemenin yazılma amacı, gebelik ve laktasyonla ilişkili osteoporoz (PLO) araştırmalarındaki son gelişmeler hakkında bir güncelleme sağlamak ve spesifik tedaviler için mevcut kanıtları özetlemektir. PLO, gebeliğin üçüncü trimesterinde ve doğum sonrası dönemde doğurganlık çağındaki kadınları etkileyen geçici ve nadir bir osteoporoz şeklidir. PLO'nun patofizyolojisi tam olarak anlaşılamamış olsa da, PLO'nun ilerlemesinde geleneksel risk faktörlerinin yanı sıra gebelik ve laktasyonun rolünü vurgulayan birkaç olgu serisi, olgu çalışması ve daha az sayıda kohort çalışması mevcuttur. 1996-2023 yılları arasında PubMed, Embase, Scopus, Google Scholar, Dünya Sağlık Örgütü bölgesel veri tabanlarından gebelik ve laktasyonla ilişkili osteoporozla ilgili çeşitli olgu çalışmaları, olgu serileri, kohort çalışmaları, meta-analizler ve anlatı incelemelerini içeren yaklaşık 300 araştırma ve inceleme makalesi incelenmiştir. Yaygın klinik belirtiler arasında bel ve kalça ağrısı ve nadiren vertebral kompresyon kırıkları yer almaktadır. Hamilelik ve emzirme döneminde kadınlar mineral homeostazında ve iskelet metabolizmasında geri dönüşümlü değişikliklere maruz kalırlar. Gebelik sırasında artan kalsiyum emilimi ve idrarla atılımı ve laktasyonda renal kalsiyum geri emilimi ile birlikte artan kemik rezorpsiyonu, sırasıyla fetüsün ve yenidoğanın iskelet büyümesini ve gelişimini destekleyen ana maternal metabolik adaptasyonlardır. PLO'nun yönetimi, biyokimyasal kemik döngüsü belirteçleri ve kemik histomorfometrisi kullanılarak doğru tanı ve prognoza bağlıdır. Geleneksel yöntemler arasında kalsiyum ve D vitamini takviyesi, emzirmenin bırakılması, fizyoterapi, destekleyici breysler ve yatak istirahati yer almaktadır. Bisfosfonatlar, denosumab ve teriparatid yaygın olarak reçete edilen ilaçlardır ve bazı yan etkilerinin yanı sıra kemik mineral yoğunluğunun iyileşmesini sağlarlar. Olguların geçici doğası ve az bildirilmesi göz önünde bulundurularak, tedavi önerileri parite, laktasyon süresi, kırık varlığı veya yokluğu, toplumsal statü, yaş, etnik köken ve ırka göre kişiselleştirilmelidir. Öz The purpose of writing this review is to provide an update on recent advances in pregnancy and lactation-associated osteoporosis (PLO) research and summarize the current evidence for specific treatments. PLO is a transient and rare form of osteoporosis that affects women of childbearing age during the third trimester of pregnancy and post-partum. Though the pathophysiology of the PLO is poorly understood, several case series, case studies, and fewer cohort studies are available highlighting the role of pregnancy and lactation apart from conventional risk factors in the progression of PLO. Approximately 300 research and review articles related to PLO have been read from 1996 to 2023 which include several case studies, case series, cohort studies, meta-analyses, and narrative reviews from PubMed, Embase, Scopus, Google Scholar, World Health Organization regional databases. Common clinical manifestations include lower back and hip pain and rarely vertebral compression fractures. During pregnancy and lactation, women undergo reversible changes in mineral homeostasis and skeletal metabolism. Increased calcium absorption and urinary excretion during pregnancy and increased bone resorption along with renal calcium reabsorption in lactation are the main maternal metabolic adaptations that support the skeletal growth and development of the fetus and newborn respectively. Management of the PLO depends upon proper diagnosis and prognosis using biochemical bone turnover markers and bone histomorphometry. Conventional methods include calcium and vitamin D supplementation, giving up breastfeeding, physiotherapy, supportive braces, and bed rest. Bisphosphonates, denosumab, and teriparatide are commonly prescribed medications, assuring the recovery of bone mineral density besides certain side effects. Considering the transient nature, and underreporting of the cases, treatment recommendations should be personalized based on the parity, duration of lactation, presence or absence of fractures, societal status, age, ethnicity, and race.
... It has a high a nity for mineralized bone and can selectively act on bone to inhibit osteoclast activity and induce osteoclast apoptosis, thereby inhibiting bone resorption and improving bone density, thereby reducing revision rate and prolonging the service life of prosthetics. Reduces the risk of recurrent fractures [3][4][5][6]. It has been reported that a single injection of ZA can effectively improve bone mineral density (BMD) for at least 12 months [7] and has a positive effect on male BMD [8]. ...
Purpose: To investigate the effects of zoledronic acid (ZA) combined with calcium tablets and calcitriol on bone mineral density (BMD), hip function after total hip arthroplasty (THA). Methods: 50 elderly patients with THA from January 2022 to December 2022 were included in this study. The ZA group was given ZA combined with calcium tablets and calcitriol, while the control group was only given calcium tablets and calcitriol. The preoperative and postoperative BMD, bone metabolism-related indexes, Harris score, incidence of prosthesis loosening and hip biomechanics between the two groups were compared. Results: There were no significant differences in age, sex, Body Mass Index. Postoperative systemic BMD and periprosthetic BMDin ZA group were higher than those in the control group. The BMD in Gruen zones 1, 6 and 7 at postoperative 6 months, Gruen zones 1, 2, 4, 6 and 7 at postoperative 1 year was significantly higher than that in the control group. Postoperative 1 year, the 25-hydroxyvitamin D, procollagen 1 intact N-terminal and Harris score in ZA group were higher than those in control group, the β-type Ⅰ collagen carboxy-terminal peptide was lower. Acetabular height and acetabular deviation in ZA group were significantly better than those in control group at postoperative 1 year. Only 2 cases of prosthesis loosening in control group. Conclusion: ZA can effectively restore the loss of BMD, maintain the biomechanical stability of the hip, and reduce the incidence of prosthesis loosening. It is an effective method to prevent osteoporosis after THA. Trial registration: This study has been registered in the Chinese Clinical Registry (registration No.: ChiCTR2200065144, date: January 2022)
... It presents with back pain and vertebral compression fractures. 2 The management of PLO is challenging, but early diagnosis, stopping breastfeeding, treatment of anti-osteoporosis medicine, and regular follow-ups are necessary for the prevention of fractures and to increase the mother's quality of life. 3,4 We present a very rare case of a 22-year-old woman, who has been diagnosed with PLO 5 months after delivering her child. ...
Key Clinical Message
Any pregnant or lactating woman with severe constant back pain, PLO must be kept in mind due to its effect on the quality of life of the mother and her child.
Abstract
A 22‐year‐old woman, who delivered her first child 5 months ago and is now breastfeeding her baby, presented with mid‐back pain. After investigations, including laboratory tests, X‐rays, and bone density measurements, the diagnosis was PLO. The patient is being treated with calcium, vitamin D, and alendronate besides discontinuation of lactation.
... A 34-year-old female was treated with TPT followed by ZOL (in a recent case published in 2023) with a good outcome registered by central DXA and high-resolution peripheral quantitative CT scans, but reported values remained lower than similar controls at 40 months after delivery. Genetic tests (considering the traditional panel for monogenic osteoporosis) were negative, thus being suggestive of a polygenic involvement in the pathogenic loop of osteoporosis [58]. ...
... 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]. ...
... Concerning the types of assessment among the mentioned studies, we found that one study [48] performed a genetic analysis (in addition to two of the case reports [58,62]), another cohort started from a large series of MRI scans [49], and two other studies (and a case report) used high-resolution peripheral quantitative CT [47,48,58]. Two studies analyzed the fracture rate within one year, respectively 2 years since delivery in larger cohorts [41,44]. ...
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.
