AB0892 PREGNANCY AND LACTATION ASSOCIATED OSTEOPOROSIS: FIRST CASE SERIES IN IRAN
Authors: M. Aghaei, S. Sedighi, M. Hassani, M. R. Damirchi
Journal: Annals of the Rheumatic Diseases (2020)

Background: Osteoporosis is a common rheumatologic disorder in postmenopausal women which could lead to morbidities later in life. However, this condition has not been properly studied in premonapausal women. During pregnancy, the fetus needs a total of 30 grams of calcium for its skeleton and during lactation, 200 mg of calcium is secreted in the breast milk per day which the mother acquires by doubling its intestinal absorption rate. If the calcium intake of the mother is not sufficient to satisfy the fetus’ needs, it will be provided by bone resorption, which will decrease the maternal calcium reserves [1]. Pregnancy and Lactation Associated Osteoporosis (PLAO) is a rare condition associated with pregnancy that should be considered in premenopausal women. The most commonly affected sites are the vertebrae and, more rarely, the hips, pubic rami and ribs [2]. An important complication of osteoporosis is fracture and a preemptive diagnosis and treatment thereof, can have drastic effects on the quality of life. Objectives: Our objective is to document the relevant risk factors, present signs and symptoms, course of illness, and response to treatment in three cases of PLAO. It is quite possible that osteoporosis in pregnancy and lactation is more frequent than recognized, simply because it is only recognized when an-unexpected fracture occurs[3]. Thus, in this article we are presenting three cases that showcase the need for more rigorous research on PLAO risk factors, the need for screening in high risk patients, and the advantages of early detection in patients’ outcome. Methods: The clinical cases of the patients whose PLAO diagnoses had been confirmed by both a radiologist and a rheumatologist in the past year was extracted. Information related to demographic indices, clinical manifestations, and the treatment methods was evaluated and compared. Results: In the past year, three patients with a chief complaint of low-back pain have visited our clinic. The first, a 22-year-old woman with a nursing history of 2 months, the next one, a 31-year-old woman with a nursing history of 3 months, and the last, a 22-year-old woman with a nursing history of 4 months. All three patients had low back pain and tenderness. Two out of three patients had deficient vitamin D levels and the other had a normal one. All three patients had low BMD in lumbar vertebra and MRI imagings indicative of osteoporotic fracture. Table 1. General and pregnancy-relatedcharacteristics of the case studies Variables Case 1 Case 2 Case 3 Age 22 31 22 Nursing duration 2 months 3months 4months BMD(lumbar spine ) -3.6 -3.5 -3.1 Vitamin D level 12.6(ng/ml) 31.6(ng/ml) 8(ng/ml) Fracture T 12, L 1 T 4,5,6,7,10 ,L 2 L 1,2,3,4,5 Conclusion: Since the symptoms of PLAO are often confused with pain in other low-back pain conditions associated with pregnancy, PLAO is a mostly overlooked diagnosis[4]. It is only recognized when an unexpected fracture occurs [3]Therefore, high risk patients with less severe symptoms are usually not diagnosed and thusly, should undergo a proper screening test, so that they are recognized early and the morbid sequelae are averted. References: [1]Kovacs, C. S., and S. H. Ralston. “Presentation and Management of Osteoporosis Presenting in Association with Pregnancy or Lactation.” Osteoporosis International , vol. 26, no. 9, 2015, pp. 2223–2241., doi:10.1007/s00198-015-3149-3. [2]Gregorio, Silvana Di, et al. “Osteoporosis with Vertebral Fractures Associated with Pregnancy and Lactation.” Nutrition , vol. 16, no. 11-12, 2000, pp. 1052–1055., doi:10.1016/s0899-9007(00)00430-5. [3]Bartl, Reiner, and Christoph Bartl. “The Osteoporosis Manual.” 2019, doi:10.1007/978-3-030-00731-7. [4]Eroglu, Semra, et al. “Evaluation of Bone Mineral Density and Its Associated Factors in Postpartum Women.” Taiwanese Journal of Obstetrics and Gynecology , vol. 58, no. 6, 2019, pp. 801–804., doi:10.1016/j.tjog.2019.09.013. Disclosure of Interests: None declared