Endocrine Abstracts

Introduction: Pregnancy-related osteoporosis represents a very rare pathology, which manifests through fractures that appear during pregnancy or early postpartum in patients who didn’t have related risk factors prior to the pregnancy. Due to the low number of cases reported, this pathology raises problems regarding diagnosis, etiology and the optimal treatment scheme, as we are going to illustrate through the following case. The etiology of this pathology is unknown – the vascular and neurogenic hypotheses have been suggested so far.

Methods: We are presenting the case of a 34 year old patient, who started to complain of cervical-thoracic-lumbar spine pain 2 days postpartum, which grew in intensity and determined her to ablactate after 2 months. The infectious and hematologic etiologies were excluded and the MRI and histopathologic exams revealed severe osteoporotic lesions in her hips and spine. The diagnosis was confirmed by osteodensitometry. The patient started treatment with denosumab 60 mg every 6 months, calcium and vitamin D, which she followed for four years, with significant increase in bone density (BMD increase in L1–L4 from 0.592 g/cm² to 0.863 g/cm²), then she stopped.

Results: The last evaluation revealed a small increase in bone density compared to the previous year, with no further fragility fractures. The patient expressed her desire to have another pregnancy. We considered there weren’t any contraindications, but she was informed about the risk of new fractures.

Conclusions: Raising the suspicion of this rare diagnosis in a patient who complains of intense bone pain during pregnancy or early postpartum could prevent osteoporotic fractures.