Endocrine Abstracts

Introduction: According to published data, pregnancy-associated osteoporosis is a rare disease, the pathophysiology of which is currently not fully explored.

Сlinical case: In 2014, a 27 year-old patient B. after the first childbirth, pain appeared in the lumbosacral spine, for which a course of physical therapy was carried out with a short-term positive effect. In 2016 after the second childbirth, pains increased; according to the results of further examination, severe osteoporosis was revealed. According to densitometry (DXA) - the maximum decrease in bone mineral density (BMD) according to the Z-score in L₁-L₄ до -3.7 SD; MRI visualized compression fractures of the vertebral bodies Th_{5, 8, 10}. Later, vitamin D deficiency was verified (8.0 ng/ml), and colecalciferol was recommended to take 6000 IU/day in combination with calcium citrate and carbonate 500 mg/day, followed by ibandronic acid 150 mg once a month. In December 2019, MRI revealed new compression fractures of the vertebral bodies (Th₆ - 60%, Th₇ - 40%, Th₁₁ - 40%). In order to exclude contraindications to the prescription of anabolic therapy, a blood test for the M-gradient was performed, followed by hematologist and oncologist consultation; multiple myeloma was not found. In this connection, in 2020 Teriparatide 20 mg subcutaneously daily was initiated, after 18 months the patient was transferred to zoledronic acid infusion. During hospitalization in the endocrinology hospital in December 2023, secondary hyperparathyroidism was diagnosed due to the use of bisphosphonates and insufficient calcium intake: PTH – 76.86 pg/ml (15-65), Ca adj. – 2.1 mmol/l (2.15-2.55). Therapy with calcium carbonate + calcium lactogluconate 1000 mg/day was recommended, the dose of colecalciferol is adjusted to 3000 IU daily. According to DXA, positive dynamics were noted - BMD was within the age norm (L_1-4 -1.2 SD; in the femur and radius: -1.3 SD and -1.2 SD, respectively).

Conclusion: The described case confirms the relevance of timely identification of risk factors and emphasizes the need to develop a personalized approach to the diagnosis and treatment of osteoporosis associated with pregnancy.