Pregnancy or lactation-related
osteoporosis (PLO) is a very rare and debilitating condition which is usually diagnosed during the last trimester of the pregnancy or early postpartum period. Herein, we report a case with severe PLO and multiple vertebral
compression fractures that were successfully treated with
teriparatide. Twenty-three-year-old female patient was admitted to our clinic two months after her first spontaneous vaginal delivery with the complaint of severe
back pain. Bone mineral density was measured using dual energy X-ray absorptiometry (DEXA), and low T- and Z-scores were observed in lumbar vertebrae. In vertebral MRI, severe height loss was detected in thoracic (T) 5,7,10,11,12 vertebrae. After exclusion of the other possible causes of OP, she was diagnosed to have PLO and the lactation was stopped. She was treated with
calcium 1000 mg/day,
cholecalciferol 800 mg/day and
teriparatide 20 µg/day. At the 12th and 18th month of
therapy, BMD was increased by 8% and 27%, respectively, at the lumbar spine and
pain was completely relieved in few months. There are pharmacological
therapy modalities that can be used in PLO.
Bisphosphonates are effective, but there are some concerns that they accumulate in bone and may expose fetus in subsequent pregnancies.
Teriparatide is a strong candidate to be the optimal medical
therapy in severe cases since it is effective and safe.