9379 From Diagnosis To Treatment: A Comprehensive Approach To Pregnancy-Related Osteoporosis With Teriparatide

Abstract

Abstract Disclosure: C. Hubers: None. M. Renzu: None. V. Mehta: None. A. Manzoor Qazi: None. A.M. Satei: None. D.K. Yerasuri: None. Introduction: Pregnancy and lactation related osteoporosis (PLO) is a rare but serious condition with significant consequences for maternal and fetal health. Teriparatide's efficacy in treating this condition is promising, particularly given concerns about bisphosphonate use in this population. Clinical Case: A 26-year-old white female sought evaluation for concerns arising after her first pregnancy. Following delivery via Cesarean section, she experienced acute back pain, instability while walking and frequent falls. A subsequent bone scan showed superior end plate fractures of T9, T11, T12, and L1, while an MRI of the lumbosacral spine showed mild acute to subacute compression deformities involving the superior endplates of the L2-L5 vertebral bodies. Despite having Factor V Leiden disease, her medical history is unremarkable for significant chronic conditions or comorbidities affecting bone health. Bone density scans revealed a Z-score of -2.4 in the lumbar spine and -1.6 in the total hip, with a femoral neck Z-score of -1.3. Her lumbar spine T-score was reported as -2.8, reflecting significant bone mineral density (BMD) loss with a BMI of 20.67. She underwent thorough testing to rule out other potential contributory conditions, such as celiac disease and hemochromatosis, but was eventually diagnosed with PLO. Treatment was initiated with teriparatide, administered as a daily 20 µg subcutaneous injection. The patient demonstrated an excellent response, with marked improvements in pain and enhanced ability to perform daily activities. After treatment with teriparatide, the patient’s c-telopeptide also improved. Discussion: PLO is a very rare manifestation of osteoporosis, mainly affecting women with lower BMI and advanced age. The etiology involves hormonal changes, increased calcium demands during pregnancy and lactation, and decreased BMD. Our patient's history and clinical course highlight a compelling instance of PLO, likely attributed to decreased estrogen exposure secondary to amenorrhea and breastfeeding, resulting in increased bone turnover. While bisphosphonates are often recommended for PLO, concerns about safety in pregnant and lactating women underscore the need for alternative treatments like teriparatide. Potential effects on gestational age, neonatal birth weight, and neonatal calcium levels have been observed in newborns with maternal exposure to bisphosphonates. Teriparatide is a synthetic form of parathyroid hormone that works primarily by stimulating osteoblast activity, leading to increased bone formation and BMD. It also enhances calcium and phosphate absorption in the kidneys and intestines, further contributing to its bone-building effects. Our patient's response to teriparatide emphasizes its potential as a safer option in managing PLO, warranting further research to establish comprehensive management guidelines. Presentation: 6/3/2024