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A case of pregnancy and lactation-associated osteoporosis and a review of the literature

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Abstract

Introduction

The pregnancy and lactation-associated osteoporosis (PLO) is a rare disease whose precise pathophysiological mechanisms remain mostly unknown.

Case report

We reported here a case of PLO that occurred in the early postpartum period and led to multiple compression fractures. Combination therapy with alendronate, calcium carbonate, and vitamin D was used to treat the patient and a marked but gradual increase in the density of bone mineral was observed. Moreover, no further fractures have occurred.

Conclusion

PLO is a very rare type of osteoporosis associated with severe chronic back pain. Increased bone resorption significantly increases the risk of bone fractures in women with PLO. Early diagnosis, stopping breastfeeding, treatment of calcium and vitamin D, bisphosphonates, or other antiosteoporosis medicine and regular follow-ups of these cases are particularly important in the prevention of fractures and to increase the quality of life of patients.

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References

  1. Kanis JA, Cooper C, Rizzoli R, Reginster JY (2018) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int

  2. Kuroda T, Nagai T, Ishikawa K, Inagaki K (2019) Clinical features and diagnosis of lumbar fractures caused by pregnancy- and lactation-associated osteoporosis. Clin Calcium 29:46–50

    PubMed  Google Scholar 

  3. NORDIN BE, ROPER A (1955) Post-pregnancy osteoporosis; a syndrome? LANCET 268:431–434

    CAS  PubMed  Google Scholar 

  4. Gehlen M, Lazarescu AD, Hinz C, Boncu B, Schmidt N, Pfeifer M, Schwarz-Eywill M, Pollahne W, Minne HW (2017) Pregnancy and lactation-associated osteoporosis. Z Rheumatol 76:274–278

    CAS  PubMed  Google Scholar 

  5. Ferrari S, Bianchi ML, Eisman JA, Foldes AJ, Adami S, Wahl DA, Stepan JJ, de Vernejoul MC, Kaufman JM (2012) Osteoporosis in young adults: pathophysiology, diagnosis, and management. Osteoporos Int 23:2735–2748

    CAS  PubMed  Google Scholar 

  6. Peris P, Guanabens N, Monegal A, Pons F, Martinez DOM, Ros I, Munoz-Gomez J (2002) Pregnancy associated osteoporosis: the familial effect. Clin Exp Rheumatol 20:697–700

    CAS  PubMed  Google Scholar 

  7. Winarno AS, Kyvernitakis I, Hadji P (2014) Successful treatment of 1-34 parathyroid hormone (PTH) after failure of bisphosphonate therapy in a complex case of pregnancy associated osteoporosis and multiple fractures. Z Geburtshilfe Neonatol 218:171–173

    CAS  PubMed  Google Scholar 

  8. 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 29:922–928

    CAS  PubMed  Google Scholar 

  9. Campos-Obando N, Oei L, Hoefsloot LH, Kiewiet RM, Klaver CC, Simon ME, Zillikens MC (2014) Osteoporotic vertebral fractures during pregnancy: be aware of a potential underlying genetic cause. J Clin Endocrinol Metab 99:1107–1111

    CAS  PubMed  Google Scholar 

  10. Butscheidt S, Delsmann A, Rolvien T, Barvencik F, Al-Bughaili M, Mundlos S, Schinke T, Amling M, Kornak U, Oheim R (2018) Mutational analysis uncovers monogenic bone disorders in women with pregnancy-associated osteoporosis: three novel mutations in LRP5, COL1A1, and COL1A2. Osteoporos Int 29:1643–1651

    CAS  PubMed  Google Scholar 

  11. Kovacs CS (2014) Bone development and mineral homeostasis in the fetus and neonate: roles of the calciotropic and phosphotropic hormones. Physiol Rev 94:1143–1218

    CAS  PubMed  Google Scholar 

  12. Kovacs CS (2011) Calcium and bone metabolism disorders during pregnancy and lactation. Endocrinol Metab Clin N Am 40:795–826

    CAS  Google Scholar 

  13. Kovacs CS, Kronenberg HM (1997) Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation. Endocr Rev 18:832–872

    CAS  PubMed  Google Scholar 

  14. Eller-Vainicher C, Ossola MW, Beck-Peccoz P, Chiodini I (2012) PTHrP-associated hypercalcemia of pregnancy resolved after delivery: a case report. Eur J Endocrinol 166:753–756

    CAS  PubMed  Google Scholar 

  15. Kovacs CS, Ralston SH (2015) Presentation and management of osteoporosis presenting in association with pregnancy or lactation. Osteoporos Int 26:2223–2241

    CAS  PubMed  Google Scholar 

  16. Trotter M, Hixon BB (1974) Sequential changes in weight, density, and percentage ash weight of human skeletons from an early fetal period through old age. Anat Rec 179:1–18

    CAS  PubMed  Google Scholar 

  17. Kovacs CS (2005) Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia 10:105–118

    PubMed  Google Scholar 

  18. Wysolmerski JJ (2010) Interactions between breast, bone, and brain regulate mineral and skeletal metabolism during lactation. Ann N Y Acad Sci 1192:161–169

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Dobnig H, Kainer F, Stepan V, Winter R, Lipp R, Schaffer M, Kahr A, Nocnik S, Patterer G, Leb G (1995) Elevated parathyroid hormone-related peptide levels after human gestation: relationship to changes in bone and mineral metabolism. J Clin Endocrinol Metab 80:3699–3707

    CAS  PubMed  Google Scholar 

  20. Stiegler C, Leb G, Kleinert R, Warnkross H, Ramschak-Schwarzer S, Lipp R, Clarici G, Krejs GJ, Dobnig H (1995) Plasma levels of parathyroid hormone-related peptide are elevated in hyperprolactinemia and correlated to bone density status. J Bone Miner Res 10:751–759

    CAS  PubMed  Google Scholar 

  21. Kovacs CS, Chik CL (1995) Hyperprolactinemia caused by lactation and pituitary adenomas is associated with altered serum calcium, phosphate, parathyroid hormone (PTH), and PTH-related peptide levels. J Clin Endocrinol Metab 80:3036–3042

    CAS  PubMed  Google Scholar 

  22. Rabbani SA, Khalili P, Arakelian A, Pizzi H, Chen G, Goltzman D (2005) Regulation of parathyroid hormone-related peptide by estradiol: effect on tumor growth and metastasis in vitro and in vivo. ENDOCRINOLOGY 146:2885–2894

    CAS  PubMed  Google Scholar 

  23. Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I (2017) Pregnancy-associated osteoporosis: a case-control study. Osteoporos Int 28:1393–1399

    CAS  PubMed  Google Scholar 

  24. Ozturk G, Akpinar P, Karamanlioglu AD, Ozkan FU, Aktas I (2018) Pregnancy-related osteoporotic vertebral compression fractures in two patients treated with low-molecular-weight heparin during pregnancy: case reports. Gynecol Endocrinol 34:378–380

    CAS  PubMed  Google Scholar 

  25. Michalakis K, Peitsidis P, Ilias I (2011) Pregnancy- and lactation-associated osteoporosis: a narrative mini-review. Endocr Regul 45:43–47

    CAS  PubMed  Google Scholar 

  26. Nakamura Y, Kamimura M, Koiwai H, Kato H (2018) Adequate nutrition status important for bone mineral density improvement in a patient with anorexia nervosa. Ther Clin Risk Manag 14:945–948

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Nakamura Y, Kamimura M, Ikegami S, Mukaiyama K, Komatsu M, Uchiyama S, Kato H (2015) A case series of pregnancy- and lactation-associated osteoporosis and a review of the literature. Ther Clin Risk Manag 11:1361–1365

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Zhang M, Chen P, Li B, Du J, Pan T, Chen J (2017) Approach to the patient with pregnancy and lactation-associated osteoporosis: a case report and a review of the literature. Medicine (Baltimore) 96:e8671

    Google Scholar 

  29. Holick MF (2007) Optimal vitamin D status for the prevention and treatment of osteoporosis. Drugs Aging 24:1017–1029

    CAS  PubMed  Google Scholar 

  30. Li L, Zhang J, Gao P, Lv F, Song Y, Chang X, Zhao D, Wang O, Jiang Y, Xing X, Xia W, Li M (2018) Clinical characteristics and bisphosphonates treatment of rare pregnancy- and lactation-associated osteoporosis. Clin Rheumatol 37:3141–3150

    PubMed  Google Scholar 

  31. Grizzo FM, Da SMJ, Pinheiro MM, Jorgetti V, Carvalho MD, Pelloso SM (2015) Pregnancy and lactation-associated osteoporosis: bone histomorphometric analysis and response to treatment with zoledronic acid. Calcif Tissue Int 97:421–425

    CAS  PubMed  Google Scholar 

  32. Minsker DH, Manson JM, Peter CP (1993) Effects of the bisphosphonate, alendronate, on parturition in the rat. Toxicol Appl Pharmacol 121:217–223

    CAS  PubMed  Google Scholar 

  33. Ozturk C, Atamaz FC, Akkurt H, Akkoc Y (2014) Pregnancy-associated osteoporosis presenting severe vertebral fractures. J Obstet Gynaecol Res 40:288–292

    CAS  PubMed  Google Scholar 

  34. Sun LM, Lin MC, Muo CH, Liang JA, Kao CH (2014) Calcitonin nasal spray and increased cancer risk: a population-based nested case-control study. J Clin Endocrinol Metab 99:4259–4264

    CAS  PubMed  Google Scholar 

  35. Sanchez A, Zanchetta MB, Danilowicz K (2016) Two cases of pregnancy- and lactation- associated osteoporosis successfully treated with denosumab. Clin Cases Miner Bone Metab 13:244–246

    PubMed  Google Scholar 

  36. Ijuin A, Yoshikata H, Asano R, Tsuburai T, Kikuchi R, Sakakibara H (2017) Teriparatide and denosumab treatment for pregnancy and lactation-associated osteoporosis with multiple vertebral fractures: a case study. Taiwan J Obstet Gynecol 56:863–866

    PubMed  Google Scholar 

  37. Boyce RW, Varela A, Chouinard L, Bussiere JL, Chellman GJ, Ominsky MS, Pyrah IT (2014) Infant cynomolgus monkeys exposed to denosumab in utero exhibit an osteoclast-poor osteopetrotic-like skeletal phenotype at birth and in the early postnatal period. BONE 64:314–325

    CAS  PubMed  Google Scholar 

  38. Kostenuik PJ, Smith SY, Jolette J, Schroeder J, Pyrah I, Ominsky MS (2011) Decreased bone remodeling and porosity are associated with improved bone strength in ovariectomized cynomolgus monkeys treated with denosumab, a fully human RANKL antibody. BONE 49:151–161

    CAS  PubMed  Google Scholar 

  39. 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) 11:495–500

    Google Scholar 

  40. 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 88:652–658

    CAS  Google Scholar 

  41. Coskun BI, Sarpel T, Guzel R (2014) Short-term treatment experience with teriparatide in pregnancy- and lactation-associated osteoporosis. J Obstet Gynaecol 34:736

    Google Scholar 

  42. Yun KY, Han SE, Kim SC, Joo JK, Lee KS (2017) Pregnancy-related osteoporosis and spinal fractures. Obstet Gynecol Sci 60:133–137

    PubMed  PubMed Central  Google Scholar 

  43. Tsuchie H, Miyakoshi N, Hongo M, Kasukawa Y, Ishikawa Y, Shimada Y (2012) Amelioration of pregnancy-associated osteoporosis after treatment with vitamin K(2): a report of four patients. Ups J Med Sci 117:336–341

    PubMed  PubMed Central  Google Scholar 

  44. Tanriover MD, Oz SG, Sozen T, Kilicarslan A, Guven GS (2009) Pregnancy- and lactation-associated osteoporosis with severe vertebral deformities: can strontium ranelate be a new alternative for the treatment? Spine J 9:e20–e24

    PubMed  Google Scholar 

  45. 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 11:139–141

    PubMed  PubMed Central  Google Scholar 

  46. Abrahamsen B, Grove EL, Vestergaard P (2014) Nationwide registry-based analysis of cardiovascular risk factors and adverse outcomes in patients treated with strontium ranelate. Osteoporos Int 25:757–762

    CAS  PubMed  Google Scholar 

  47. Bayram S, Ozturk C, Sivrioglu K, Aydinli U, Kucukoglu S (2006) Kyphoplasty for pregnancy-associated osteoporotic vertebral fractures. Joint Bone Spine 73:564–566

    PubMed  Google Scholar 

  48. Kim HW, Song JW, Kwon A, Kim IH (2010) Percutaneous vertebroplasty for pregnancy-associated osteoporotic vertebral compression fractures. J Korean Neurosurg Soc 47:399–402

    PubMed  PubMed Central  Google Scholar 

  49. Kezunovic M, Bulatovic N, Kadic V (2017) Bilateral subcapital femoral neck fracture in a 28 year old postpartum woman. Mediev Archaeol 71:151–153

    Google Scholar 

  50. Tsvetov G, Levy S, Benbassat C, Shraga-Slutzky I, Hirsch D (2014) Influence of number of deliveries and total breast-feeding time on bone mineral density in premenopausal and young postmenopausal women. MATURITAS 77:249–254

    PubMed  Google Scholar 

  51. More C, Bhattoa HP, Bettembuk P, Balogh A (2003) The effects of pregnancy and lactation on hormonal status and biochemical markers of bone turnover. Eur J Obstet Gynecol Reprod Biol 106:209–213

    CAS  PubMed  Google Scholar 

  52. 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 29:135–142

    CAS  PubMed  Google Scholar 

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Author notes

  1. Pu Jia and RuiDeng Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing, China

    Pu Jia, RuiDeng Wang, Hao Chen, Li Bao, Fei Feng & Hai Tang

  2. Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang, Dongcheng District, Beijing, China

    Jing Yuan

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  1. Pu Jia
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Jia, P., Wang, R., Yuan, J. et al. A case of pregnancy and lactation-associated osteoporosis and a review of the literature. Arch Osteoporos 15, 94 (2020). https://doi.org/10.1007/s11657-020-00768-7

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