Smith R, Athanasou N A, Ostlere S J, Vipond S E
Nuffield Orthopaedic Centre, Headington, Oxford.
QJM. 1995 Dec;88(12):865-78.
The clinical features, investigation and outcome in 24 patients with pregnancy-associated osteoporosis, followed for up to 24 years from the first pregnancy are described. Symptoms occurred most often in the first pregnancy (17 patients) at a mean age of 27 years (range 21-36); the most frequent was back pain in late pregnancy or post partum (n = 18); less common was hip (n = 5) or ankle (n = 1) pain. In most, symptoms improved soon after delivery. Four subjects had pre-existing disorders known to reduce bone density (corticosteroid therapy, heparin treatment, mild osteogenesis imperfecta and previous anorexia nervosa). Radiographs showed vertebral collapse or localized osteoporosis of the hip, with MRI evidence of oedema. Forearm bone mineral density (BMD) was sometimes normal, but spinal BMD (measured by DXA) was low. Bone biopsies in eleven patients showed features compatible with osteoblast failure. Except for the patient with mild osteogenesis imperfecta, cultured dermal fibroblasts synthesized and exported normal Type I collagen. In 14 subsequent pregnancies (10 patients) there was no recurrence in ten and mild symptoms in the remainder. Excluding one patient who had repeated osteoporotic fractures and vertebral collapse, the long-term prognosis was good.
本文描述了24例妊娠相关性骨质疏松症患者的临床特征、检查及预后情况，这些患者从首次妊娠起随访长达24年。症状最常出现在首次妊娠时（17例患者），平均年龄为27岁（范围21 - 36岁）；最常见的是妊娠晚期或产后背痛（n = 18）；较少见的是髋部疼痛（n = 5）或踝部疼痛（n = 1）。大多数患者在分娩后症状很快改善。4名受试者有已知会降低骨密度的既往疾病（皮质类固醇治疗、肝素治疗、轻度成骨不全症和既往神经性厌食症）。X线片显示椎体塌陷或髋部局限性骨质疏松，MRI有水肿证据。前臂骨密度（BMD）有时正常，但脊柱BMD（通过双能X线吸收法测量）较低。11例患者的骨活检显示与成骨细胞功能衰竭相符的特征。除轻度成骨不全症患者外，培养的皮肤成纤维细胞合成并分泌正常的I型胶原蛋白。在随后的14次妊娠中（10例患者），10例无复发，其余患者症状轻微。排除1例反复发生骨质疏松性骨折和椎体塌陷的患者，长期预后良好。
