Endocrine Abstracts

Introduction: Pregnancy and lactation associated osteoporosis (PLO) is a rare condition in which women typically present with fractures, often vertebral, in the third trimester of pregnancy or in the early postpartum period. Bone loss of 3–10% at the spine and hip are seen over 3–6 months of lactation. Bone loss is related to duration of lactation and amenorrhea and is not prevented by calcium supplementation.

Methods: We studied a woman of 45 years, in the third trimester of pregnancy, who suffered from constant low back pain, which prevented her to walk properly. Three months after childbirth, she underwent by DXA severe osteoporosis characterized by multiple vertebral fractures. Bone markers as alkaline phosphatase, osteocalcin, serum β-cross laps, PTH, 25OHD, 24 h urine calcium were assessed. Secondary causes of osteoporosis were also studied by specific laboratory tests: TSH, ematology, renal and epatic function, proteins, CA125, and CA15-3. All of them were considered within normal range. Patient suffered from reflux and esophagitis. Osteogenesis imperfecta were also excluded. We choose to treat her with osteoanabolic PTH 1–84 therapy.

Results: DXA showed increase in BMD at lumbar site after 18 months of PTH 1–84 treatment. Biochemical parameters increased at the 6th and the 12th month and then reducted, as described in the literature, at the 18th month of therapy. During this period the patient showed marked improvement in the lumbar algodistrofia, being able to walk slowly.

Conclusion: As this disorder is likely to be heterogeneous in its etiology and prognosis, a through evaluation for secondary causes of osteoporosis should be undertaken in all cases of PLO. Results obtained in our clinical experience confirm the efficacy of PTH 1–84 therapy on high risk of fracture in PLO, documented increase of T-score at the spine, besides the increase of β-Ctx and osteocalcin levels.