Background: Pregnancy- and lactation-associated osteoporosis (PLO) is an uncommon disease which is usually presented in the third trimester or early post-partum and the prominent clinical feature is the severe and prolonged back pain and height loss. To date the prevalence and the aetiology of this disorder are unclear and there are no guidelines for its treatment.
Methods: We report the outcomes of sequential treatment with teriparatide and denosumab in a woman suffering from severe PLO with 6 fragility vertebral fractures, severe back pain and remarkable low BMD.
Results: Breastfeeding was terminated (2 months after delivery) and treatment was started with calcium 500 mg/day, vitamin D3 2.200 IU/day and teriparatide 20 μg/day for 2 years followed by denosumab 60 mg/6 month. Shortly after the initiation of teriparatide treatment, back pain gradually decreased. One year later, the patient was almost free of back pain without new clinical vertebral fractures and her laboratory tests were normal. After 2 years of teriparatide treatment, BMD increased by 35.6% at the lumbar spine and 5.8% and 16.2% at the left total and femur neck, respectively. After one more year of demosumab treatment, BMD found to be increased from the base line values by 41.5% at the lumbar spine and 12.6% and 11.2% at the left total and femur neck, respectively.
Conclusion: Women with PLO may suffer from fragility vertebral fracture(s), often multiple, which cause severe and disabling back pain and kyphosis. Treatment with teriparatide, simultaneously with weaning, calcium and vitamin D supplementation, may increase considerably BMD, improve back pain and quality of life and prevent further occurrence of vertebral fractures. In order to preserve or further increase BMD following teriparatide treatment, sequential treatment with denosumad proved a reasonable option.
Disclosure: The authors declared no competing interests.