Endocrine Abstracts

Objective: Pregnancy-related osteoporosis is a rare disorder with potentially severe complications. There is lack of clinical practice guidelines due to low incidence of this disease and few published cases.

Material and methods: We present eight cases of pregnancy-related osteoporosis in women aged between 28–42 years. Six of them were diagnosed between 1 month and 3 years postpartum and two were diagnosed in the third trimester of pregnancy. Most of them had otherwise healthy pregnancy, only one woman had risk factors promoting osteoporosis before pregnancy (heparin treatment).

Results: Blood tests showed normocalcemia and normophosphatemia in all patients. All patients except one had PTH level within normal range (one patient had secondary hyperparathyroidism due to vitamin D deficiency). Serum osteocalcin level was available in four patients, 3/4 had low levels of osteocalcin. Seven patients had multiple vertebral compression fractures at X-ray with a prominent decrease in BMD (spinal Z-score from −2.2 to −4.4) and one patient suffered bilateral femoral neck fracture. Treatment approaches included therapy with calcium (1000–2000 mg/day) and vitamin D (alfacalcidol 0.5–3 mcg/day or cholecalciferol 10,000–15,000 IU/week) in all patients; five patients had received specific treatment for osteoporosis (bisphosphonates in two patients, calcitonin spray in one patient, denosumab in one patient and sequential therapy with strontium ranelate, denosumab and teriparatide in one patient). Four women underwent surgery: three had vertebroplasty and one had bilateral hip replacement. Follow-up data was available in six patients with median 2 years, 5/6 had radiological improvement in lumbar spine.

Conclusion: Described cases confirm the severity of pregnancy-related osteoporosis and its challenging management. Necessity and regimen of specific treatment are the subject for further research. Women diagnosed with pregnancy-related osteoporosis should be advised to have appropriate calcium and vitamin D intake and counseled regarding the risk of potential detrimental effects on the bone health during breastfeeding and newborn care.