Sarli Marcelo, Hakim Carina, Rey Paula, Zanchetta José
Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires.
Medicina (B Aires). 2005;65(6):489-94.
Both generalized and regional osteoporosis exceptionally occur during pregnancy and lactation. The aim of this paper is to show our experience in the diagnosis and treatment of these diseases. From 1984 to 2004 six lactating women with osteoporosis and two with regional osteoporosis consulted us. In the former group, three patients had vertebral fractures and the others experienced substantial demineralization detected by dual-energy X-ray absorptiometry (DXA). In all cases, symptoms began during the third trimester of pregnancy or immediately after delivery. Five of them were primiparous and one was multiparous with a long period of lactation. Risk factors were: low calcium intake, low weight, family history of osteoporosis, amenorrhea, cigarette consumption and corticosteroid therapy. Laboratory tests evidenced increased bone turnover. DXA scan showed substantial demineralization, particularly in axial skeleton. Lactation was interrupted in all women and four received anti-resorptive drugs, one estrogen and only calcium plus vitamin D the remaining. All of them, but one, evolved successfully. The women affected by regional osteoporosis complained of unilateral pain and progressive functional limitation of right foot and left hip respectively. Reduced bone mineral density at symptomatic sites was seen by DXA. Diagnosis was confirmed by typical magnetic resonance imaging pattern. Both patients cured with rest and bisphosfonates treatment.
全身性和局部性骨质疏松症在妊娠和哺乳期极为罕见。本文旨在分享我们在这些疾病诊断和治疗方面的经验。1984年至2004年期间，有6名患有骨质疏松症的哺乳期妇女和2名患有局部性骨质疏松症的妇女前来就诊。在前一组中，3名患者发生了椎体骨折，其他患者通过双能X线吸收法（DXA）检测到明显的骨质流失。所有病例中，症状均始于妊娠晚期或分娩后立即出现。其中5名是初产妇，1名是经产妇且哺乳期较长。危险因素包括：钙摄入量低、体重轻、骨质疏松症家族史、闭经、吸烟和皮质类固醇治疗。实验室检查显示骨转换增加。DXA扫描显示明显的骨质流失，尤其是在中轴骨骼。所有女性均停止哺乳，4名接受了抗吸收药物治疗，1名接受雌激素治疗，其余仅接受钙加维生素D治疗。除1名患者外，所有患者均成功康复。患有局部性骨质疏松症的女性分别抱怨单侧疼痛以及右脚和左髋部逐渐出现功能受限。DXA显示症状部位的骨密度降低。典型的磁共振成像模式证实了诊断。两名患者均通过休息和双膦酸盐治疗治愈。
