Long-term outcome of patients with pregnancy and lactation-associated osteoporosis (PLO) with a particular focus on quality of life

Abstract

Pregnancy and lactation-associated osteoporosis (PLO) is a very rare form of osteoporosis. Vertebral fractures either occur in the last trimester of pregnancy or after childbirth. Pathogenesis is still unclear. Until recently, almost no data existed in regards to the quality of life and long-term clinical outcome of patients with PLO. To determine the long-term clinical outcome of patients with pregnancy and lactation-associated osteoporosis (PLO) with respect to the following factors: pain, quality of life, mental condition, vertebral fractures, and capacity to work. In this single-center retrospective study, patients were reviewed for at least 2years, more than 50% of them were followed up until menopause. Bone density (DXA) and vertebral fractures were assessed. Standardized questionnaires were used to analyze factors such as quality of life (Qualeffo-41), anxiety and depression (PHQ-4), and pain (the visual analog scale [VAS]). Additionally, a questionnaire was designed in order to evaluate and discuss some of the reasons behind the occurrence of mental distress at the onset of symptoms. Our report shows the clinical course of 20 patients with PLO, 11 of them until menopause (on average 16.3years after onset of symptoms). When diagnosis was made, 5.4 vertebral fractures were noticed on average. Three of the 20 patients developed subsequent fractures in the following years. The diagnosis of PLO was made on average after 3.3months after the onset of symptoms. At the beginning of the investigation, physical and mental health of all patients were poor, but improved within the first 2years and continued doing so until menopause. The average time it took to return to employment was 3.3years. PLO has a significant impact on pain, mental state, quality of life, and capacity to work. However, the long-term prognosis is promising. The severe mental distress is presumably related to several contributing factors in life such as physical integrity and independence, family life, employment, and financial security.Key Points• PLO has a strong impact on quality of life and can lead to severe mental distress.• At onset of symptoms, patients with PLO are in very poor mental and physical condition; however, the long-term outcome after inpatient rehabilitation seems to be good.• Most patients do not suffer subsequent vertebral fractures until the menopause.