Endocrine Abstracts

Introduction: Osteoporosis of pregnancy and postpartum is a rare clinical entity, which usually presents with back pain, due to spine fractures. We aimed to describe four different cases presenting with back pain and fractures post-partum, in who, with diverse underlying pathophysiology, recovery time and treatments used.

Case 1: A 32-year-old patient presented with intense back pain and difficulty in standing and walking, 2 weeks after delivery. She had hypercalcaemia, hyperphosphatemia and multiple vertebral fractures. Breast examination and mammography were inconclusive due to lactation. The diagnosis of metastatic breast cancer was made after a bone lesion biopsy. The patient received zolendronic acid and was referred to an oncologist.

Case 2: A 35 year-old patient, several weeks after a singleton pregnancy, presented with acute back pain. Imaging studies revealed an L2 fracture and laboratory assessment showed increased bone turnover markers and vitamin D deficiency. She received zolendronic acid and was started on vitamin D3 substitution. Her clinical course was uneventful.

Case 3: A 41 year-old lady was diagnosed with T12 and L3 vertebral fractures, while still breast-feeding. No secondary causes of osteoporosis were found. She received an 18-month course of teriparatide and Vitamin D3 supplementation. Six months after teriparatide discontinuation she presented with urinary tract lithiasis complicated by upper urinary tract infection.

Case 4: A 32-year-old patient presented with lumbar spine bone mineral density Z-score of −2.8, but no fractures, after her first pregnancy. She was treated with intranasal calcitonin and VitD3 supplementation. An improved BMD (Z-score=−2.1) was measured after 2 years. Her second pregnancy was uneventful.

Conclusions: Post-partum osteoporosis is a rare cause of bone pain during the puerperium. Fractures should be diagnosed early in order to avoid permanent incapacity. It is mandatory to look for and exclude secondary causes of osteoporosis including breast cancer and vitamin D deficiency.