Endocrine Abstracts

The partum period can be seen as a transient condition of “menopause” due to the physiological decline to a baseline of the high estrogens found during pregnancy, and bone metabolism is likely to alter. Moreover, high calcium requirements for fetal growth and during breastfeeding are covered in the maternal metabolism from enhanced intestinal absorption in a Calcitriol dependent pathway, and maternal bone reabsorption under control of parathyroid hormone (PTH) parathyroid-related protein (PTHrP) reportedly increased during lactation. We report a 34- years-old primiparous woman showing clinical vertebral fragility fractures that occurred shortly after childbirth while breastfeeding. Two months postpartum - in the context of lumbar pain, a spine MRI revealed recent compression fractures of T8-L2 and a 3 cm decrease of her height. She was on a restricted protein diet, with Thyroxine treatment with a gradual increase during pregnancy stopped 4 months after delivery, she received a 20 weeks period of low molecular weight heparin during pregnancy, and she had a positive history of family low bone density - with her mother on bisphosphonate treatment and her maternal grandmother - hip fracture. Secondary causes of osteoporosis were excluded, and increased bone turnover markers (betacrosslaps, alkaline phosphatase) and low bone density with a Z score of -3.6 SD in the lumbar spine and -2.1 SD total femur was found at determination. She was advised for weaning and supplement her calcium vitamin D intake. After 6 months from the first bone density test and 10 months after delivery, at her first visit to our clinic, the bone mass continues to decrease (4%), and turnover markers turned in the normal range. We proposed treatment 18 months of teriparatide - with Risendronate as possible, consolidating therapy with bisphosphonates because of his shortest persistent period.