Advertisement

Pregnancy-associated osteoporosis: a UK case series and literature review

  • S.A. HardcastleEmail author
  • F. Yahya
  • A.K. Bhalla
Review Article

Abstract

Mini Abstract: Pregnancy-associated osteoporosis (PAO) is a rare syndrome affecting women during late pregnancy and the early postpartum period. We set out to review the clinical features of ten cases of PAO from a single UK centre. Patients had attended the Royal National Hospital for Rheumatic Diseases, Bath (RNHRD) between January 2000 and June 2016. The principal criterion for inclusion was the occurrence of low trauma fractures either during pregnancy or the immediate post-partum period. Data were obtained from retrospective review of medical notes. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (Hologic ®Discovery system) at the lumbar spine and hip. Data pertaining to the pregnancy, as well as type and duration of treatment received, were reviewed. All ten cases presented with vertebral fractures. In four patients, no risk factors for fracture other than pregnancy or breastfeeding could be identified. Four patients were found to have vitamin D insufficiency at the time of diagnosis, and a further two patients had received treatment with low molecular weight heparin (LMWH). In one case, further investigation led to a diagnosis of osteogenesis imperfecta (OI) confirmed on genetic testing. In terms of treatment, eight out of the ten patients in this series received a bisphosphonate, most commonly risedronate due to its relatively short skeletal retention time. Clinicians should be aware of PAO, a rare but recognised complication of pregnancy. The condition should be especially considered in women presenting with new onset back pain in pregnancy or the postpartum period.

Keywords

Fractures Osteoporosis Pregnancy 

Notes

Compliance with ethical standards

Conflicts of interest

SH has received conference fee support from Lilly UK. FY has received funding for attending congresses and speaker fees from Pfizer, Novartis and Abbvie and grant/advisory board for Novartis. The other authors declare that they have no conflict of interest.

Supplementary material

198_2019_4842_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 14.3 kb)

References

  1. 1.
    Sanz-Salvador L, Garcia-Perez MA, Tarin JJ, Cano A (2015) Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture. Eur J Endocrinol 172:R53–R65CrossRefGoogle Scholar
  2. 2.
    Kovacs CS (2014) Osteoporosis presenting in pregnancy, puerperium, and lactation. Curr Opin Endocrinol Diabetes Obes 21:468–475CrossRefGoogle Scholar
  3. 3.
    Pearson D, Kaur M, San P, Lawson N, Baker P, Hosking D (2004) Recovery of pregnancy mediated bone loss during lactation. Bone 34:570–578CrossRefGoogle Scholar
  4. 4.
    Moller UK, Vieth Streym S, Mosekilde L, Rejnmark L (2012) Changes in bone mineral density and body composition during pregnancy and postpartum. A controlled cohort study. Osteoporos Int 23:1213–1223CrossRefGoogle Scholar
  5. 5.
    Kovacs CS (2016) Maternal mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery. Physiol Rev 96:449–547CrossRefGoogle Scholar
  6. 6.
    Hong N, Kim JE, Lee SJ, Kim SH, Rhee Y (2018) Changes in bone mineral density and bone turnover markers during treatment with teriparatide in pregnancy- and lactation-associated osteoporosis. Clin Endocrinol 88:652–658CrossRefGoogle Scholar
  7. 7.
    Kovacs CS, Ralston SH (2015) Presentation and management of osteoporosis presenting in association with pregnancy or lactation. Osteoporos Int 26:2223–2241CrossRefGoogle Scholar
  8. 8.
    Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I (2017) Pregnancy-associated osteoporosis: a case-control study. Osteoporos Int 28:1393–1399CrossRefGoogle Scholar
  9. 9.
    Kyvernitakis I, Reuter TC, Hellmeyer L, Hars O, Hadji P (2018) Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up. Osteoporos Int 29:135–142CrossRefGoogle Scholar
  10. 10.
    O'Sullivan SM, Grey AB, Singh R, Reid IR (2006) Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int 17:1008–1012CrossRefGoogle Scholar
  11. 11.
    Compston J (2013) Skeletal effects of drugs. In: Rosen CJ (ed) Primer on the metabolic bone diseases and disorders of mineral metabolism, 8th edn. John Wiley & Sons, HobokenGoogle Scholar
  12. 12.
    Ozdemir D, Tam AA, Dirikoc A, Ersoy R, Cakir B (2015) Postpartum osteoporosis and vertebral fractures in two patients treated with enoxaparin during pregnancy. Osteoporos Int 26:415–418CrossRefGoogle Scholar
  13. 13.
    Handschin AE, Trentz OA, Hoerstrup SP, Kock HJ, Wanner GA, Trentz O (2005) Effect of low molecular weight heparin (dalteparin) and fondaparinux (Arixtra) on human osteoblasts in vitro. Br J Surg 92:177–183CrossRefGoogle Scholar
  14. 14.
    Campos-Obando N, Oei L, Hoefsloot LH, Kiewiet RM, Klaver CCW, Simon MEH, Zillikens MC (2014) Osteoporotic vertebral fractures during pregnancy: be aware of a potential underlying genetic cause. J Clin Endocrinol Metab 99:1107–1111CrossRefGoogle Scholar
  15. 15.
    Cook FJ, Mumm S, Whyte MP, Wenkert D (2014) Pregnancy-associated osteoporosis with a heterozygous deactivating LDL receptor-related protein 5 (LRP5) mutation and a homozygous methylenetetrahydrofolate reductase (MTHFR) polymorphism. J Bone Miner Res 29:922–928CrossRefGoogle Scholar
  16. 16.
    Naylor KE, Bradburn M, Paggiosi MA, Gossiel F, Peel NFA, McCloskey EV, Walsh JS, Eastell R (2018) Effects of discontinuing oral bisphosphonate treatments for postmenopausal osteoporosis on bone turnover markers and bone density. Osteoporos Int 29:1407–1417CrossRefGoogle Scholar
  17. 17.
    Stathopoulos IP, Liakou CG, Katsalira A, Trovas G, Lyritis G, Papaioannou N, Tournis S (2011) The use of bisphosphonates in women prior to or during pregnancy and lactation. Hormones (Athens) 10:280–291CrossRefGoogle Scholar
  18. 18.
    Ornoy A, Wajnberg R, Diav-Citrin O (2006) The outcome of pregnancy following pre-pregnancy or early pregnancy alendronate treatment. Reprod Toxicol 22:578–579CrossRefGoogle Scholar
  19. 19.
    Levy S, Fayez I, Taguchi N, Han JY, Aiello J, Matsui D, Moretti M, Koren G, Ito S (2009) Pregnancy outcome following in utero exposure to bisphosphonates. Bone 44:428–430CrossRefGoogle Scholar
  20. 20.
    Zarattini G, Buffoli P, Isabelli G, Marchese M (2014) Pregnancy-associated osteoporosis with seven vertebral compression fractures, a case treated with strontium ranelate. Clin Cases Miner Bone Metab 11:139–141Google Scholar
  21. 21.
    Lampropoulou-Adamidou K, Trovas G, Stathopoulos IP, Papaioannou NA (2012) Case report: Teriparatide treatment in a case of severe pregnancy -and lactation- associated osteoporosis. Hormones (Athens) 11:495–500CrossRefGoogle Scholar
  22. 22.
    Hellmeyer L, Boekhoff J, Hadji P (2010) Treatment with teriparatide in a patient with pregnancy-associated osteoporosis. Gynecol Endocrinol 26:725–728CrossRefGoogle Scholar
  23. 23.
    Choe EY, Song JE, Park KH, Seok H, Lee EJ, Lim SK, Rhee Y (2012) Effect of teriparatide on pregnancy and lactation-associated osteoporosis with multiple vertebral fractures. J Bone Miner Metab 30:596–601CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Royal National Hospital for Rheumatic DiseasesBathUK
  2. 2.Department of MedicineUniversity of MalayaKuala LumpurMalaysia

Personalised recommendations