Endocrine Abstracts

Introduction: Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition in which women have fragile fractures associated with significant reduction of BMD during pregnancy or postpartum period.

Case report: A 37-year-old female patient was admitted at our Clinic for further investigation of aetiology of osteoporosis in July 2019. Soon after delivery in February 2019 patient had felt left hip and foot pain as well as sharp intensive pain (intensity 9/10) in thoracic spine with propagation anteriorly into intercostal spaces. Pain was increased during body position changes, and was alleviated with ibuprofen intake. She also complained on morning stiffness. MRI of thoracic spine was performed in June and it showed irregularly decreased height of thoracic vertebrae 7 and 8, which seemed as compressive fractures. Osteodensitometry showed osteoporosis with total T-score of spine -2.8 (L3 -3.1), Z-score -2.6(L3 -3.0) and osteopenia of the hip with T-score of neck of the femur -1.1, Z-score -1.1. Trabecular bone score indicated preserved microarchitecture of bones. On admission she complained of malaise, cold hands and feet, tingling in legs and dry mouth with occasional problem swallowing solids and liquids. First menstrual period after the delivery was in July and it is also when she stopped breast-feeding. In the previous years she had a spontaneous miscarriage and 3 tries of insemination. During 1^st trimester she was on progesterone therapy. She had an operation of myoma in 2015. Her family history is positive for CVD, DM, and lung carcinoma. Patient is a smoker (did not stop during the pregnancy). Full laboratory workup showed normal calcium and PTH levels, with vitamin D insufficiency. Thyroid hormones, FSH, LH, prolactin, testosterone, and cortisol were within normal reference range as well as electrophoresis of proteins, tumour markers, Bence-Jones protein. Vertebral fracture assessment indicated crush fracture of L4. After all workup, we concluded that this is a case of pregnancy and lactation -associated osteoporosis and we advised vitamin D 2000IU, calcium-carbonate 1000 mg. In December 2019, she received a first dose of zolendronic acid. On a first check-up 6 months later, X-ray of thoracic spine was performed and it showed new pathological fractures of toracic vertebra 9 and 11 so she received 2nd dose of zolendronic acid. Third dose was applied in December 2021. Next osteodensitometry is scheduled for March 2022.

Conclusion: PLO is a rare condition and it should be considered as differential diagnosis in patients with back pain during or after pregnancy.