Bone Abstracts

Introduction: Pregnancy- and lactation-associated osteoporosis (PLO) is an uncommon disease. The majority of cases are seen in the third trimester or early post-partum in the primagravid women and the prominent clinical feature of PLO is the severe and prolonged back pain and height loss. To date the prevalence and the aetiology of this disorder are unclear and there are no guidelines for its treatment.

Case report: We report the outcomes of teriparatide (TRP) treatment in a woman suffering from severe PLO with six fragility vertebral fractures, severe back pain very low BMD and low levels of vitamin D.

Results: Breast-feeding was terminated (2 months after delivery) and treatment was started with calcium 500 mg/day, vitamin D₃ 2.200 IU/day and TRP 20 μg/day. Shortly after the initiation of TRP treatment, the back pain gradually decreased. Thirteen months later, the patient was almost free of back pain. There was no new clinical vertebral fracture. Her laboratory tests were all normal. BMD increased by 24.4% at the lumbar spine, 9.9 and 4.6% at the left and the right total hip and 12.6 and 7.8% at the left and right femur neck, respectively.

Conclusion: Women with PLO may suffer from fragility vertebral fracture(s), often multiple, which cause severe and disabling back pain and kyphosis in the third trimester of pregnancy or in the early post-partum. Treatment with TRP which stimulates bone formation, simultaneously with weaning, calcium and vitamin D supplementation, increases considerably BMD, improves severe back pain and quality of life, and prevents further occurrence of vertebral fractures, making TRP a helpful tool in restoring bone strength in PLO patients.