Poster Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Abstract:

Introduction

Pregnancy and lactation-associated osteoporosis (PLO) is a rare but significant condition characterised by fractures during pregnancy or the postpartum. We report a case of severe PLO with multiple vertebral fractures and kyphosis necessitating various antiresorptive and anabolic treatments.

Case Report:

A 38-year-old woman presented with vertebral fractures following her second pregnancy. She had regular menstrual cycles, no history of malnutrition or eating disorders, and developed gestational diabetes in both pregnancies. Despite treatment with calcium and vitamin D, spontaneous vertebral fractures continued, as shown in annual magnetic resonance imaging (MRI) surveillance [Figure 1], [table 1]. Nutritional screenings were normal, and screenings for secondary osteoporosis as well as genetic testing for osteogenesis imperfecta were negative. Over the years, she was treated with Strontium, Risedronate, Denosumab, Teriparatide, and Zoledronate without significant improvement in bone density and experienced a 14 cm loss in height. In 2014, she underwent bariatric surgery, resulting in significant weight loss. Severe kyphosis led to restrictive lung disease, necessitating CPAP use. After progressive fractures, she was treated with Romosozumab, showing some improvement in bone density (6.2% density gain at femoral neck and 22.9% at the lumbar spine) (Table 2).

PLO typically presents in late pregnancy or early postpartum, with vertebral fractures being common. The incidence is approximately 0.4 per 100,000 pregnancies [1]. PLO's pathophysiology includes nutritional deficiencies and hormonal changes during pregnancy. Genetic variants may also play a role [2]. Management focuses on pain relief, fracture stabilization, and preventing further bone loss. Bisphosphonates and other treatments like Denosumab, Teriparatide, and Romosozumab can improve bone mineral density (BMD) [3]. Our case highlights severe PLO with bariatric surgery as an additional risk factor and varied response to treatments.

Conclusion:

PLO is a rare condition. Further studies are needed to determine the best treatment options and their timing and duration.