Endocrine Abstracts

Introduction: Of interest are cases of osteoporosis of unknown etiology after a recent delivery.

Matherials and methods: A 33-year-old woman complained of frequent fractures of the bones of both feet (four times in the last year) after the birth of her third child. For the woman, this was the fourth pregnancy, according to her, after the birth of her second child, she had pain in the lower back, which aggravated with physical exertion (at 24 years old).

Results: The patient’s calcium level was 2.37 mmol/l, phosphorus 1.25 mmol/l, vitamin D - 20.07 ng/ml, parathyroid hormone - 50.04 pg/ml, NTx - 79.74 nM BCE (normal 17- 94 nM BCE), osteocalcin - 5.28 ng/ml (normal 6-43 ng/ml), alkaline phosphatase - 60.0 U/l. Dual-energy x-ray absorptiometry (DEXA) showed that the Z-score of 1-4 lumbar vertebrae was -3.3, the left hip was -2.2, the neck of the left femur -2.3, the right hip -2.8, the neck right thigh -2.0. The analysis of the obtained results showed that the resorption markers were within the normal range, and the formation markers were below the norm, therefore it was advisable to prescribe teriparatide, but due to the lack of access to teriparatide in our country, we prescribed the patient a calcium preparation 1000 mg per day, osteogenon 6 tablets per day, alendronic acid 70 mg per week and vitamin D at a dose of 300,000 IU. Repeatedly after 2.5 months, all parameters remained unchanged, except for vitamin D (20.07→34.89) and NTx (79.74→75.60), osteocalcin (5.28→2.93), alkaline phosphatase also decreased (60→54). The patient was then switched to teriparatide 20 mg subcutaneously once daily. After 6 months, during therapy with teripartide, osteocalcin increased from 2.93 to 13.82, the same situation was observed in relation to alkaline phosphatase (54→185). X-ray densitometry parameters also had positive shifts: Z-score of 1-4 lumbar vertebrae increased from -3.3 to -2.6, Z-score of the left hip -3.2→2.9, right hip -2.8→2, 6. Based on the positive changes in the results of laboratory and functional studies, it was recommended to continue therapy with teriparatide. The patient is being monitored.

Conclusion: Pregnancy and the lactation period are physiological for a woman’s body, the development of osteoporosis during pregnancy and lactation, not due to other reasons, requires further research.