Introduction: Pregnancy or lactation related osteoporosis (PLO) is very rare. It usually occurs in the third trimester or in the early post partum period and manifestations are severe back pain and loss of height due to vertebral fractures. Its etiology is not well understood. Classical treatment is cessation of lactation, calcium and Vit-D supplementation and biphosphanates in chosen cases. All osteoporosis drugs are approved mainly for post-menouposal osteoporosis and reports of teriparatide treatment in this group of patients is off label worldwide. Here, we represented a case with severe pregnancy related osteoporosis to whom we started teriparatide treatment.
Case: 23-year-old female patient admitted at the post partum 2nd week with complaints of severe back pain. She denoted that pain started in the last month of her pregnancy and persisted after labour despite calcium and Vit-D supplementation. Her BMI was 24 kg/m2, had regular menstrual cycles, and she didnt have any risk factors for osteoporosis such as smoking, corticosteroid usage or family history. Thyroid functions, parathormone level, celiac markers, kidney and liver function tests, serum Ca, P and Vit D levels were in normal ranges. We detected multiple vertebral fractures at T5, T7, T10, T11, T12 and her total vertebrate Z-score was −4.2 where as femur neck Z-score was −1. We have initiated teriparatide therapy 20 μg/day along with 1000 mg calcium and 800 IU cholecalciferol per day. Thorocal orthosis was also prescribed. At the second month of therapy her pain was totally relieved. At the 6th month of therapy BMD was increased 15% ath the lumbar spine and we continued the therapy.
Conclusion: Effective treatment of PLO is controversial. There are some concerns about biphosphanates in premenouposal age group because of possible adverse effects on fetus. They accumulate in bone and can cross placenta despite withdrawal. In previous reports teriparatide caused increased BMD up to 36%. It can also prevent futher vertebral fractures. It can be a reasonable choice for treatment.