Endocrine Abstracts

Context: Pregnancy and lactation -associated osteoporosis (PLO) is an uncommon condition affecting women during late pregnancy and the early postpartum period. PLO is manifested with fractures usually in spine or occasionally in the hip with severe and prolonged pain and height loss. Pathogenesis of this rare condition is still not completely understood.

Case Presentation: We report a 28 y/o female patient presenting with severe back pain during postpartum period. Vertebral and Lumbar MRI revealed Th11, Th12, L1, L2 and L4 compressive fractures while DEXA scan reported severe osteoporosis - L1-L4 Z-score = -5.1 with maximal reduction of BMD in L4 -Z score - 5.6. Secondary causes of osteoporosis such as: celiac disease, Cushing Syndrome, hyperparathyroidism and hyperthyroidism were excluded. Patient was prescribed Calcium, Vitamin D, denosumab 60 mg SC every 6 months and lifestyle modification. She was consulted about the risks of severe osteoporosis, as well as possible teratogenic effects of the antiosteoporotic medication and proper contraception was advised. On repeated DEXA scan after 1 year showed improvement in bone density. After 18 months of PLO diagnosis unplanned pregnancy was confirmed. Regarding the challenges of maternal and fetal health the group discussion with Endocrinologist and Gynecologist was conducted. Patient was informed about the risks of further fractures during pregnancy and postpartum, risks of discontinuation and subsequently withdrawal of denosumab, as well as possible teratogenic effects of osteoporosis treatment. After careful judgment patient decided to terminate pregnancy and continue osteoporosis treatment with Calcium, Vitamin D and bisphoshonates.

Conclusion: We should bear in mind the possibility of pregnancy and lactation -associated osteoporosis in women with persistent back pain during pregnancy or postpartum period. Early diagnosis, proper management and patient education is crucial for maternal as well as for fetal health. Lack of data regarding antiosteoporotic treatment during pregnancy is a challenge for patients and the care takers. Further research and more evidence is needed for further guidance.