Endocrine Abstracts

Objectives: The cases described in the literature, with postpartum and lactation osteoporosis, are very rare.

Material: A case report: 28 years old women, that give birth to a 3250 g weight term child, APGAR 10, breast feeding period: 3 months, with acute back pain starting the 2nd months after delivery. On the moment our evaluation she resumed breastfeeding.

3 months after delivery she came in our office with diagnosed acute vertebral fractures T8, L1 and severe bone demineralization: lumbar spine T score =−4.7, and femoral neck T score =−2.7.

Method: Clinic evaluation: back pain, no somatic sign and symptom of any disease.

We performed: total blood count, HSS, fibrinogen, rheumatoid factor, TSH, FT4, cortisolemia, intact PTH, 25 HO vitamin D, total calcemia, phosphatemia, creatinine, uree, beta 2 microglobuline, bone turnover markers: osteocalcin, crosslaps, total alkaline phosphatase, cromogranina A, serotonin, beta 2 microglobulin, immunoelectrophoresis.

Imagistic evaluation: DEXA antero-posterior technique, cranial, thoracic, abdominal and pelvic CT scan, thoracic and abdominal MRI, cervico-toracal-lumbar-sacral radiographies, breast ductal echography, bone scintigraphy.

Results: The only anomalies we found were increased bone turnover: with repeated normal calcemia and phosphatemia levels. The diagnostic of postpartum osteoporosis was made after exclusion of: primary and secondary hyperparathyroidism, severe hyperthyroidism, Cushing’s disease, osteomalacia, severe vitamin D insufficiency, multiple myeloma, Paget disease, bone cancer, bone metastatic disease, breast cancer, any type of other cancer, apparent neuroendocrine tumors.

A paraneoplasic syndrome was excluded for the moment.

Periodically markers will be performed.

The patient was put on injectable bisphosphonates.

Conclusion: Postpartum osteoporosis is an exclusion diagnostic, which need active follow-up.