Pregnancy-associated osteoporosis: Long-term follow-up of a patient with two pregnancies

Abstract

Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition. Its pathogenesis and etiology are unknown. It is frequently observed in the last trimester of pregnancy and during lactation period in primigravida. The symptoms may begin with back and hip pain. In addition, it could be complicated by osteoporotic fractures and disability. Here, we report a long-term (7 years) follow-up of a 29-year-old patient who underwent two pregnancies and was diagnosed with PLO both the times. The first time this patient was admitted to our outpatient clinic with a complaint of severe back pain, she was in the lactation period of her first pregnancy. Laboratory findings, X-ray imaging and densitometry revealed osteomalacia (25-OH Vit D = 6.8 ng/dL), multiple vertebral fractures (T6-T9-T11-T12-L1), and osteoporosis (L1–L4 T-score: –4.6). After the treatment for vitamin D deficiency, she was treated with risedronate and Ca-vitamin D supplementation. At the end of the 2-year follow-up, she terminated the use of risedronate [by her own decision] and continued with the Ca–vitamin D supplementation. Six years after the first pregnancy, she became pregnant again. In the postpartum period, she complained about gait difficulty, and severe hip and back pain. With the help of laboratory results, imaging, and densitometry (L1–L4 T-score: –3.9), she was diagnosed with PLO second time, and was treated with zoledronic acid, in addition to Ca–vitamin D supplementation. Once back pain occurs in the postpartum period, PLO should be considered in differential diagnosis even if the patient is taking Ca–vitamin D supplementation.