Pregnancy and lactation-associated osteoporosis in a patient with rheumatoid arthritis: case report and literature review

Abstract

Clinical data of a 33-year-old rheumatoid arthritis patient accompanied with pregnancy and lactation-associated osteoporosis (PLO) was retrospectively reviewed. The patient had two pregnancies within three years, and bone pain occurred during lactation of the second pregnancy after 2 months of delivery. Dual-energy X-ray (DEXA) showed decreased bone density, while thoracolumbar spine and pelvic X-ray film suggested osteoporosis. Her rheumatoid arthritis was stable and previous treatment did not include glucocorticoids. Other causes of metabolic bone diseases were excluded and the diagnosis of PLO was confirmed. The breastfeeding was stopped; calcium, active vitamin D, alendronate sodium were administrated, and the treatment was effective. Domestic and international literature from January 2000 to January 2019 was searched and no cases of PLO accompanied with rheumatoid arthritis were reported. There were only 100 cases of PLO retrieved in the literature, including 19 cases of PLO in China reported by four articles. It is suggested that PLO should be considered in RA patients presenting with arthragia during the lactation, in addition to relapse of disease. Awareness of PLO should be increased in physicians, especially rheumatologists, and anti-osteoporosis therapy is effective in patients with PLO. Key words: Rheumatoid arthritis; Osteoporosis; Pregnancy; Lactation