Pregnancy and lactation-associated osteoporosis (PAO) is a rare syndrome of spontaneous fragility fractures, most commonly vertebral, occurring in late pregnancy or lactation. The aetiology and pathogenesis of this osteoporosis are unknown, and early diagnosis and management are essential because of the severity of the morbidity associated with these fractures. The management includes cessation of breastfeeding, use of specific osteoporosis drugs, and adequate analgesia.
We present two cases of young women who developed PAO in the background of no known risk factors for secondary osteoporosis or bone disease. The first case is a 29-year-old lady who presented with bilateral hip pain during the last month of her pregnancy. The pain persisted 2 weeks after delivery, and at that point she had a fall and sustained bilateral neck of femur fracture. The second case is a 34-year-old lady who presented with back pain after the birth of her second child and similar pain persisted with her subsequent two pregnancies. In both cases, DEXA scan showed evidence of osteoporosis and biochemical tests have ruled out other risk factors. The first patient was started on and improved with oral bisphosphonate therapy, and the second patient was managed conservatively.
In conclusion, although a rare syndrome, PAO has to be considered in young pregnant or postpartum women presenting with persistent back/hip pain or spontaneous fragility fractures as early diagnosis and management can avoid the potential debilitating morbidity associated with it.