Endocrine Abstracts

Background: Pregnancy and lactation induced osteoporosis (PLO) presenting as spinal fractures in late pregnancy or early postpartum period is a rare condition. The risk factors and pathophysiology are still incompletely understood. The impact of the disorder on the young mother’s quality of life can be profound, further aggravated by a delay in diagnosis and treatment that often occurs.

Aim: To delineate clinical parameters related to fractures in a group of women with PLO, and to compare risk factors and osteoporosis-related quality of life with a control group.

Methods: Participants of a social media (WhatsApp) group for women with PLO were offered a questionnaire, including a specific osteoporosis-related quality of life section (MINI OQLQ). Mothers of young children in parent WhatsApp groups were approached to serve as a random control.

Results: Twenty-four patients with PLO and 43 healthy controls (36.9±4.8 vs 38.8±4.3 y.o, P=0.11) were included in the study. Fifty percent of patients suffered from fractures of more than 5 vertebrae, 25% of 4 and 25% had 3 or less vertebrae involved, 85.7% of the fractures were a-traumatic. Nineteen percent of the fractures occurred during pregnancy and others, during early postpartum period. Diagnosis was delayed for more than 16 weeks in 41.8% of women. Bone mineral density test was performed in all participants in the PLO group and 62.5% were treated with teriparatide. A significantly lower proportion of women in the PLO group engaged in physical activity over 2 h/week during pregnancy (37.5 vs. 86.3%, P<0.05) and more PLO patients were treated with low-molecular-weight-heparin during pregnancy, although the difference was of borderline significance (P=0.06). No difference was observed in smoking, periods of amenorrhea, lactation, or family history of fractures between the groups. Seventy-one percent of the PLO patients expressed fear of fractures and 58.3% fear of falls compared to none and 2.3%, respectively (P<0.01) of the controls.

Conclusions: PLO-related spinal fractures involve multiple vertebrae in the majority of the affected women, and the diagnosis is delayed in many. Less physical activity might pose a risk. Most of PLO patients in our cohort were treated with teriparatide. PLO patients reported a significant impairment of quality of life. Multidisciplinary effort should be exerted to early identification and treatment of this severe condition.