Ota Kuniaki, Asanuma Yuta, Hirasawa Hideyuki, Ohta Hiroaki, Takahashi Toshifumi
Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima City, Fukushima, Japan.
Department of Obstetrics and Gynecology, Tokyo Rosai Hospital, Ota-ku, Tokyo, Japan.
Ther Adv Musculoskelet Dis. 2024 Jul 26;16:1759720X241259897. doi: 10.1177/1759720X241259897. eCollection 2024.
Pregnancy- and lactation-associated osteoporosis (PLO) is a rare type of premenopausal osteoporosis, typically occurring during the third trimester of pregnancy and the early postpartum lactation period. This report presents a case involving severe multiple vertebral fractures due to PLO with low bone mineral density (BMD) and heightened bone turnover. A 39-year-old primiparous Japanese woman reported low back pain (LBP) starting at 28 weeks of pregnancy. The pain temporarily improved after delivery, although the LBP recurred and worsened 2 months into breastfeeding. Thereafter, the patient visited the Obstetrics and Orthopedic departments. Plain radiographs of the thoracic and lumbar spine showed loss of vertebral body height at the T4-12 and L1-3,5 vertebrae, leading to a diagnosis of 13 fractured vertebrae. BMD and serum bone turnover markers revealed low bone density and heightened bone turnover. In the absence of any identified alternative cause of secondary osteoporosis, the diagnosis was severe PLO with 13 vertebral fractures related to pregnancy and lactation. After treatment with bisphosphonates and an active vitamin D analog, the patient exhibited an increased BMD and normalization of bone turnover and resumed regular daily activities. Although the optimal PLO treatment strategy remains uncertain, bisphosphonates are an option; however, bisphosphonates can potentially affect the fetus through placental transfer. Therefore, careful consideration is required for patients planning pregnancy. Despite bisphosphonates' widespread use and cost-effectiveness, selecting PLO medications involves multiple factors, necessitating further research.
妊娠和哺乳期骨质疏松症（PLO）是一种罕见的绝经前骨质疏松症，通常发生在妊娠晚期和产后早期哺乳期。本报告介绍了一例因PLO导致严重多发性椎体骨折的病例，该患者骨密度（BMD）低且骨转换增加。一名39岁的初产日本女性在怀孕28周时开始出现腰痛（LBP）。分娩后疼痛暂时缓解，但在母乳喂养2个月后LBP复发并加重。此后，患者就诊于妇产科和骨科。胸腰椎X线平片显示T4 - 12及L1 - 3、5椎体的椎体高度丢失，诊断为13处椎体骨折。BMD和血清骨转换标志物显示骨密度低且骨转换增加。在未发现任何继发性骨质疏松症的其他明确病因的情况下，诊断为严重PLO伴13处与妊娠和哺乳相关的椎体骨折。在用双膦酸盐和活性维生素D类似物治疗后，患者的BMD增加，骨转换恢复正常，并恢复了日常正常活动。尽管PLO的最佳治疗策略仍不确定，但双膦酸盐是一种选择；然而，双膦酸盐可能通过胎盘转移对胎儿产生潜在影响。因此，计划怀孕的患者需要仔细考虑。尽管双膦酸盐广泛使用且具有成本效益，但选择PLO药物涉及多个因素，需要进一步研究。
