Challenges in the Management of Pregnancy and Lactation-Associated Osteoporosis (PLO) in Women of Childbearing age With Multiple Vertebral Fractures

Yang Liu,Genlong Jiao,Zhizhong Li

doi:10.18483/ijsci.2233

Abstract

Pregnancy and lactation-associated osteoporosis (PLO) is a rare but serious and difficult to be diagnosed disease, which occurs in the late gestation and early lactation, mainly manifested by low back pain, vertebral fracture and reduction of hip bone density. It is difficult to diagnose and has a high rate of misdiagnosis and mistreatment. We present the case of a 39-year-old woman who suffered from acute low back pain and walking difficulty after a sudden stoop in 2 months postnatal. The X-ray and MRI examination showed that fractures occurred in the first, second and fifth lumbar vertebrae. Bone mineral density (BMD) examination confirmed osteoporosis. After stopping lactation, calcium and vitamin K2 supplemented, compared with zoledronic acid injection, the low back pain was relieved and the BMD increased gradually. The incidence of PLO is seriously underestimated in clinical practice. Women in pregnancy and lactation with acute low back pain should be highly alert to the occurrence of PLO, and early treatment need to be taken in case of further serious consequences such as vertebral compression fracture or hip fracture.

Highlights

Pregnancy and Lactation-Associated Osteoporosis (PLO) is a rare disease that causes back pain and multiple vertebral compression fractures in women of childbearing age, with which the pathogenesis is not clear and no standard diagnosis or treatment were carried out at present
Diphosphate combined with calcium, vitamin C and vitamin D is considered as the main treatment for osteoporosis
Butscheidt, S et al [6] detected some new mutations in LRP5, COL1A1 and COL1A2 genes in 7 patients with PLO, which played an important role in the occurrence and development of Pregnancy and lactation-associated osteoporosis

Summary

Introduction

PLO is a rare disease that causes back pain and multiple vertebral compression fractures in women of childbearing age, with which the pathogenesis is not clear and no standard diagnosis or treatment were carried out at present. We present a case of 39-year-old woman suffering from PLO with multiple lumbar compression fractures (L1, L2, L5), who obtained a visibly relieve by the combined treatment of calcium, vitamin D, vitamin K2 and zoledronic acid. T2 fat suppression sequence of lumbar MRI showed that the L1, L2 and L5 vertebrae got high signal and decreased in height, indicating the fresh compression fracture with myeloedema (Figure 1). She was healthy and menstruating regularly before becoming pregnant, and had been breast-feeding for six months before menstruating again, with no history of blue sclera, dental dysplasia or long-term use of corticosteroids. The followed up lumbar MRI in second and seventh month showed that edema of vertebral fracture decreased significantly and no new fracture was found (Figure 2, 3)

Findings

Discussion

Conclusion