Effective strategies for pregnancy and lactation-associated osteoporosis: teriparatide use in focus.
PLO
Pregnancy and lactation-associated osteoporosis
Teriparatide
lactation
Journal
Endocrine
ISSN: 1559-0100
Titre abrégé: Endocrine
Pays: United States
ID NLM: 9434444
Informations de publication
Date de publication:
15 Jul 2024
15 Jul 2024
Historique:
received:
18
05
2024
accepted:
26
06
2024
medline:
15
7
2024
pubmed:
15
7
2024
entrez:
15
7
2024
Statut:
aheadofprint
Résumé
Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition characterized by fragility fractures occurring during late pregnancy or lactation, primarily affecting the spine and causing significant morbidity and back pain. PLO can lead to mobility impairment and work incapacity, with recovery taking up to several years. Due to the lack of clinical trials, treatment strategies remain poorly defined, historically focusing on calcium supplements, vitamin D, and weaning from breastfeeding. However, recent attention has turned to teriparatide (TPD) as an option due to its anabolic properties and potential suitability for women of childbearing age. This review evaluates TPD's use in PLO treatment, using published systematic reviews and case studies. Over 300 cases with PLO were identified through PubMed, Google Scholar, and Cochrane searches until August 2023. We identified 175 cases with PLO treated with TPD alone or followed by antiresorptive therapy. Most women (85.7%) were primiparas. The mean ± SD duration of TPD use was 15 ± 6 months. Among the study patients, 91.4% used TPD alone, while 8.6% (15/175) utilized sequential therapy. Approximately 93% of our cohort exhibited potential risk factors for PLO. Despite the increased risk of recurrent fractures in PLO, only 14.7% (20/175) of those treated with TPD sustained new fractures during a 9-month to 9 years' follow-up period. The mean ± SD percent increase in BMD at the LS was 21.14% ± 7.4%, and at the FN it was 12.1% ± 9.3%. The baseline Z-scores at the LS ranged from -3.3 (-3.7 to -2.7), while the baseline Z-scores at the FN ranged from -2.0 (-2.7 to -1.5). This review emphasizes PLO severity, advocating for increased awareness and timely interventions. TPD emerges as a promising therapeutic option in certain cases.
Identifiants
pubmed: 39008200
doi: 10.1007/s12020-024-03946-6
pii: 10.1007/s12020-024-03946-6
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
N. Hong et al. Changes in bone mineral density and bone turnover markers during treatment with teriparatide in pregnancy- and lactation-associated osteoporosis. Clin. Endocrinol. 88(5), 652–658 (2018)
doi: 10.1111/cen.13557
R. Smith et al. Pregnancy-associated osteoporosis. Qjm 88(12), 865–878 (1995)
pubmed: 8593546
S. Butscheidt et al. Relevant genetic variants are common in women with pregnancy and lactation-associated osteoporosis (PLO) and predispose to more severe clinical manifestations. Bone 147, 115911 (2021)
pubmed: 33716164
doi: 10.1016/j.bone.2021.115911
C. Mourgues, S. Malochet-Guinamand, M. Soubrier, Refractory rheumatic disorder: Atypical postpregnancy osteoporosis. Case Rep. Rheumatol. 2015, 1–4 (2015)
K. Lampropoulou-Adamidou et al. Teriparatide treatment in patients with pregnancy- and lactation-associated osteoporosis. Calcif. Tissue Int. 109(5), 554–562 (2021)
pubmed: 34132853
doi: 10.1007/s00223-021-00871-y
M. Laroche et al. Pregnancy-related fractures: a retrospective study of a French cohort of 52 patients and review of the literature. Osteoporos. Int. 28(11), 3135–3142 (2017)
pubmed: 28879474
doi: 10.1007/s00198-017-4165-2
I. Kyvernitakis et al. Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up. Osteoporos. Int 29(1), 135–142 (2018)
pubmed: 28965212
doi: 10.1007/s00198-017-4239-1
W. Khovidhunkit, S. Epstein, Osteoporosis in pregnancy. Osteoporos. Int. 6(5), 345–354 (1996)
pubmed: 8931028
doi: 10.1007/BF01623007
A.J. Phillips, S.J. Ostlere, R. Smith, Pregnancy-associated osteoporosis: does the skeleton recover? Osteoporos. Int 11(5), 449–454 (2000)
pubmed: 10912848
doi: 10.1007/s001980070113
M. Toba et al. Fractures within 2 years of an obstetric hospitalization: analysis of nationwide administrative data in Japan. J. Bone Min. Metab. 40(5), 748–754 (2022)
doi: 10.1007/s00774-022-01336-4
S. Blick, S. Dhillon, S. Keam, Teriparatide a review of its use in osteoporosis. Drugs 68, 2709–2737 (2008)
pubmed: 19093708
doi: 10.2165/0003495-200868180-00012
A. Winarno, I. Kyvernitakis, P. Hadji, Successful treatment of 1-34 parathyroid hormone (PTH) after failure of bisphosphonate therapy in a complex case of pregnancy associated osteoporosis and multiple fractures. Z. f.ür. Geburtshilfe und Neonatologie 218(04), 171–173 (2014)
doi: 10.1055/s-0034-1382069
K.Y. Yun et al. Pregnancy-related osteoporosis and spinal fractures. Obstet. Gynecol. Sci. 60(1), 133 (2017)
pubmed: 28217686
pmcid: 5313358
doi: 10.5468/ogs.2017.60.1.133
E.Y. Choe et al. Effect of teriparatide on pregnancy and lactation-associated osteoporosis with multiple vertebral fractures. J. Bone Miner. Metab. 30(5), 596–601 (2012)
pubmed: 22105654
doi: 10.1007/s00774-011-0334-0
I. Losada et al. Bisphosphonates in patients with autoimmune rheumatic diseases: Can they be used in women of childbearing age? Autoimmun. Rev. 9(8), 547–552 (2010)
pubmed: 20307690
doi: 10.1016/j.autrev.2010.03.002
B.J. Kirby et al. Upregulation of calcitriol during pregnancy and skeletal recovery after lactation do not require parathyroid hormone. J. Bone Miner. Res. 28(9), 1987–2000 (2013)
pubmed: 23505097
doi: 10.1002/jbmr.1925
B.S. Benn et al. Active intestinal calcium transport in the absence of transient receptor potential vanilloid type 6 and calbindin-D9k. Endocrinology 149(6), 3196–3205 (2008)
pubmed: 18325990
pmcid: 2408805
doi: 10.1210/en.2007-1655
C.S. Kovacs, Bone development in the fetus and neonate: role of the calciotropic hormones. Curr. Osteoporos. Rep. 9(4), 274–283 (2011)
pubmed: 21904825
doi: 10.1007/s11914-011-0073-0
S. Khosla et al. Parathyroid hormone-related protein and hypercalcemia secondary to massive mammary hyperplasia. N. Engl. J. Med 322(16), 1157 (1990)
pubmed: 2320085
doi: 10.1056/NEJM199004193221613
F. Lepre et al. Hypercalcemia in pregnancy and lactation associated with parathyroid hormone-related protein. N. Engl. J. Med. 328(9), 666–667 (1993)
pubmed: 8429868
doi: 10.1056/NEJM199303043280917
M.J. Horwitz et al. Direct comparison of sustained infusion of human parathyroid hormone-related protein-(1-36) [hPTHrP-(1-36)] versus hPTH-(1-34) on serum calcium, plasma 1,25-dihydroxyvitamin D concentrations, and fractional calcium excretion in healthy human volunteers. J. Clin. Endocrinol. Metab. 88(4), 1603–1609 (2003)
R. Koren et al. Humoral hypercalcemia of pregnancy treated with bisphosphonates. Arch. Endocrinol. Metab. 62(1), 125–128 (2018)
pubmed: 29694631
pmcid: 10118686
doi: 10.20945/2359-3997000000016
K. Sato, Hypercalcemia during pregnancy, puerperium, and lactation: Review and a case report of hypercalcemic crisis after delivery due to excessive production of PTH-related Protein (PTHrP) without Malignancy (Humoral Hypercalcemia of Pregnancy). Endocr. J. 55(6), 959–966 (2008)
pubmed: 18614854
doi: 10.1507/endocrj.K08E-092
T. Anai et al. Pregnancy-associated osteoporosis with elevated levels of circulating parathyroid hormone-related protein: a report of two cases. J. Obstet. Gynaecol. Res 25(1), 63–67 (1999)
pubmed: 10067016
doi: 10.1111/j.1447-0756.1999.tb01124.x
C.S. Kovacs, Calcium and bone metabolism disorders during pregnancy and lactation. Endocrinol. Metab. Clin. North Am. 40(4), 795–826 (2011)
pubmed: 22108281
doi: 10.1016/j.ecl.2011.08.002
E.C. O’Brien et al. Calcium intake in winter pregnancy attenuates impact of vitamin D inadequacy on urine NTX, a marker of bone resorption. Eur. J. Nutr. 57(3), 1015–1023 (2018)
pubmed: 28224220
doi: 10.1007/s00394-017-1385-3
O. Ofluoglu, D. Ofluoglu, A case report: pregnancy-induced severe osteoporosis with eight vertebral fractures. Rheumatol. Int. 29(2), 197–201 (2008)
pubmed: 18633621
doi: 10.1007/s00296-008-0641-5
L. Hellmeyer, J. Boekhoff, P. Hadji, Treatment with teriparatide in a patient with pregnancy-associated osteoporosis. Gynecol. Endocrinol. 26(10), 725–728 (2010)
pubmed: 20230328
doi: 10.3109/09513591003649831
H.A. Tran, N. Petrovsky, Pregnancy-associated osteoporosis with hypercalcaemia. Intern. Med. J. 32(9-10), 481–485 (2002)
pubmed: 12380703
doi: 10.1046/j.1445-5994.2002.00278.x
M.F. Scioscia, M.B. Zanchetta, Recent insights into pregnancy and lactation-associated osteoporosis (PLO). Int. J. Women’s. Health 15, 1227–1238 (2023)
doi: 10.2147/IJWH.S366254
C. Karlsson, K.J. Obrant, M. Karlsson, Pregnancy and lactation confer reversible bone loss in humans. Osteoporos. Int 12(10), 828–834 (2001)
pubmed: 11716185
doi: 10.1007/s001980170033
M.A. Laskey, A. Prentice, Bone mineral changes during and after lactation. Obstet. Gynecol. 94(4), 608–615 (1999)
pubmed: 10511368
D. Holmberg-Marttila, H. Sievänen, R. Tuimala, Changes in bone mineral density during pregnancy and postpartum: prospective data on five women. Osteoporos. Int. 10(1), 41–46 (1999)
pubmed: 10501778
doi: 10.1007/s001980050192
U.K. Moller et al. Changes in calcitropic hormones, bone markers and insulin-like growth factor I (IGF-I) during pregnancy and postpartum: a controlled cohort study. Osteoporos. Int 24(4), 1307–1320 (2013)
pubmed: 22855199
doi: 10.1007/s00198-012-2062-2
I. Matsumoto et al. Changes of bone mineral density in pregnant and postpartum women. J. Obstet. Gynaecol. (Tokyo 1995) 21(5), 419–425 (1995)
pubmed: 8542463
doi: 10.1111/j.1447-0756.1995.tb01031.x
N. Kolthoff et al. Bone mineral changes during pregnancy and lactation: a longitudinal cohort study. Clin. Sci. (Lond.) 94(4), 405–412 (1998)
pubmed: 9640346
doi: 10.1042/cs0940405
C. More et al. The effects of pregnancy and lactation on bone mineral density. Osteoporos. Int 12(9), 732–737 (2001)
pubmed: 11605738
doi: 10.1007/s001980170048
C.E. Fiore et al. Pregnancy-associated changes in bone density and bone turnover in the physiological state: Prospective data on sixteen women. Horm. Metab. Res 35(05), 313–318 (2003)
pubmed: 12916002
doi: 10.1055/s-2003-41308
M.A. Laskey et al. Bone changes after 3 mo of lactation: influence of calcium intake, breast-milk output, and vitamin D-receptor genotype. Am. J. Clin. Nutr. 67(4), 685–692 (1998)
pubmed: 9537615
doi: 10.1093/ajcn/67.4.685
J. Blanch, R. Pacifici, A. Chines, Pregnancy-associated osteoporosis: report of two cases with long-term bone density follow-up. Br. J. Rheumatol. 33(3), 269–272 (1994)
pubmed: 8156291
doi: 10.1093/rheumatology/33.3.269
F.J. Cook et al. Pregnancy-associated osteoporosis with a heterozygous deactivating LDL receptor-related protein 5 (LRP5) mutation and a homozygous methylenetetrahydrofolate reductase (MTHFR) polymorphism. J. Bone Min. Res. 29(4), 922–928 (2014)
doi: 10.1002/jbmr.2095
U.K. Møller et al. Changes in bone mineral density and body composition during pregnancy and postpartum. A controlled cohort study. Osteoporos. Int. 23(4), 1213–1223 (2012)
pubmed: 21607805
doi: 10.1007/s00198-011-1654-6
B. Kulkarni et al. Maternal weight and lean body mass may influence the lactation-related bone changes in young undernourished Indian women. Br. J. Nutr. 101(10), 1527–1533 (2009)
pubmed: 18959808
doi: 10.1017/S0007114508084067
T. Mori et al. Parity, lactation, bone strength, and 16-year fracture risk in adult women: findings from the Study of Women’s Health Across the Nation (SWAN). Bone 73, 160–166 (2015)
pubmed: 25528102
doi: 10.1016/j.bone.2014.12.013
G. Tsvetov et al. Influence of number of deliveries and total breast-feeding time on bone mineral density in premenopausal and young postmenopausal women. Maturitas 77(3), 249–254 (2014)
pubmed: 24332872
doi: 10.1016/j.maturitas.2013.11.003
A. Al Refaie et al. Radiofrequency echographic multi spectrometry (R.E.M.S.): New frontiers for ultrasound use in the assessment of bone status—a current picture. Diagnostics 13(10), 1666 (2023)
pubmed: 37238151
pmcid: 10217295
doi: 10.3390/diagnostics13101666
V.A. Degennaro et al. First assessment of bone mineral density in healthy pregnant women by means of Radiofrequency Echographic Multi Spectrometry (REMS) technology. Eur. J. Obstet. Gynecol. Reprod. Biol. 263, 44–49 (2021)
pubmed: 34167032
doi: 10.1016/j.ejogrb.2021.06.014
T. Kaji et al. Effect of bed rest during pregnancy on bone turnover markers in pregnant and postpartum women. Bone 40(4), 1088–1094 (2007)
pubmed: 17229597
doi: 10.1016/j.bone.2006.11.018
L. Nerius et al. Bone turnover in lactating and nonlactating women. Arch. Gynecol. Obstet. 308(6), 1853–1862 (2023)
pubmed: 37707552
pmcid: 10579129
doi: 10.1007/s00404-023-07189-0
S.M. O’Sullivan et al. Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos. Int 17(7), 1008–1012 (2006)
pubmed: 16758139
doi: 10.1007/s00198-006-0112-3
P. Hadji, N. Mouzakiti, I. Kyvernitakis, Effect of teriparatide on subsequent fracture and bone mineral density in 47 women with pregnancy- and lactation-associated osteoporosis and vertebral fractures. Geburtshilfe und Frauenheilkd. 82(06), 619–626 (2022)
doi: 10.1055/a-1816-6700
M.C. Campopiano et al. Case report: Early-onset osteoporosis in a patient carrying a novel heterozygous variant of the WNT1 gene. Front. Endocrinol. 13, 918682 (2022)
doi: 10.3389/fendo.2022.918682
A. Costa et al. PLS3 mutations in X-linked osteoporosis: Clinical and genetic features in five new families. Calcif. Tissue Int 114(2), 157–170 (2024)
pubmed: 38043102
doi: 10.1007/s00223-023-01162-4
J.N. VanHouten, J.J. Wysolmerski, Low estrogen and high parathyroid hormone-related peptide levels contribute to accelerated bone resorption and bone loss in lactating mice. Endocrinology 144(12), 5521–5529 (2003)
pubmed: 14500568
doi: 10.1210/en.2003-0892
N.B. Watts et al. Bone mineral density changes associated with pregnancy, lactation, and medical treatments in premenopausal women and effects later in life. J. Women’s Health (Larchmt.) 30(10), 1416–1430 (2021)
doi: 10.1089/jwh.2020.8989
H. Qing, L.F. Bonewald, Osteocyte remodeling of the perilacunar and pericanalicular matrix. Int. J. Oral. Sci. 1(2), 59–65 (2009)
pubmed: 20687297
pmcid: 3470108
doi: 10.4248/ijos.09019
X.S. Liu et al. Mechanical regulation of the maternal skeleton during reproduction and lactation. Curr. Osteoporos. Rep. 17(6), 375–386 (2019)
pubmed: 31755029
pmcid: 7373497
doi: 10.1007/s11914-019-00555-5
R. Terzi et al. A rare cause of postpartum low back pain: pregnancy- and lactation-associated osteoporosis. Biomed. Res Int 2014, 287832 (2014)
pubmed: 25525595
pmcid: 4265516
doi: 10.1155/2014/287832
J. Bonacker, M. Janousek, M. Kröber, Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report. Arch. Orthop. Trauma Surg. 134(2), 173–179 (2014)
pubmed: 24357025
doi: 10.1007/s00402-013-1912-5
I. Kyvernitakis et al. Correction to: Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up. Osteoporos. Int. 34(12), 2143–2144 (2023)
pubmed: 37855888
doi: 10.1007/s00198-023-06927-z
P. Anagnostis et al. Comparative effectiveness of therapeutic interventions in pregnancy and lactation-associated osteoporosis: a systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 109(3), 879–901 (2024).
pubmed: 37708365
doi: 10.1210/clinem/dgad548
S. Lee et al. Bone density after teriparatide discontinuation with or without antiresorptive therapy in pregnancy- and lactation-associated osteoporosis. Calcif. Tissue Int. 109(5), 544–553 (2021)
pubmed: 34037833
doi: 10.1007/s00223-021-00869-6
A. Cohen et al. Teriparatide for idiopathic osteoporosis in premenopausal women: A pilot study. J. Clin. Endocrinol. Metab. 98(5), 1971–1981 (2013)
pubmed: 23543660
pmcid: 3644608
doi: 10.1210/jc.2013-1172
S. Di Gregorio et al. Osteoporosis with vertebral fractures associated with pregnancy and lactation. Nutrition 16(11-12), 1052–1055 (2000)
pubmed: 11118824
doi: 10.1016/S0899-9007(00)00430-5
M. Zhang et al. Approach to the patient with pregnancy and lactation-associated osteoporosis: A case report and a review of the literature. Med. (Baltim.) 96(46), e8671 (2017)
doi: 10.1097/MD.0000000000008671
M. Gehlen et al. Long-term outcome of patients with pregnancy and lactation-associated osteoporosis (PLO) with a particular focus on quality of life. Clin. Rheumatol. 38(12), 3575–3583 (2019)
pubmed: 31468224
doi: 10.1007/s10067-019-04758-0
I.J. Chen et al. Knowledge about osteoporosis and its related factors among public health nurses in Taiwan. Osteoporos. Int 16(12), 2142–2148 (2005)
pubmed: 16133637
doi: 10.1007/s00198-005-2015-0
T.T. Hlaing, J.E. Compston, Biochemical markers of bone turnover - uses and limitations. Ann. Clin. Biochem 51(Pt 2), 189–202 (2014)
pubmed: 24399365
doi: 10.1177/0004563213515190
A.A. Khan et al. Management of endocrine disease: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management. Eur. J. Endocrinol. 180(2), R37–R44 (2019)
pubmed: 30444723
doi: 10.1530/EJE-18-0541
Y. Kaneuchi et al. Pregnancy and lactation-associated osteoporosis successfully treated with romosozumab: A case report. Med. (Kaunas.) 59(1), 19 (2022)
C. Chaniotakis et al. Pregnancy associated osteoporotic vertebral fractures: an underdiagnosed condition of back pain. J. Musculoskelet. Neuronal Interact. 21(2), 332–334 (2021)
pubmed: 34059580
pmcid: 8185266
N. Bazgir et al. Woman with pregnancy and lactation-associated osteoporosis (PLO). Case Rep. Obstet. Gynecol. 2020, 1–3 (2020)
doi: 10.1155/2020/8836583
E.T. Cerit, M. Cerit, A case of pregnancy and lactation associated osteoporosis in the third pregnancy; robust response to teriparatide despite delayed administration. Bone Rep. 13, 100706 (2020)
pubmed: 32884982
pmcid: 7451846
doi: 10.1016/j.bonr.2020.100706
F. Tuna et al. Risk factors, fractures, and management of pregnancy-associated osteoporosis: a retrospective study of 14 Turkish patients. Gynecol. Endocrinol. 36(3), 238–242 (2020)
pubmed: 31385717
doi: 10.1080/09513590.2019.1648417
J.J. Zhu et al. Systemic mastocytosis identified in two women developing fragility fractures during lactation. Osteoporos. Int 29(7), 1671–1674 (2018)
pubmed: 29619541
doi: 10.1007/s00198-018-4498-5
S.T. Tekantapeh and A. Khabbazi, Successful treatment of gonadotropin releasing hormone induced severe pregnancy and lactation-associated osteoporosis with teriparatide. Clin. Cases Min. Bone Metab. 15(1), (2018)
A. Ijuin et al. Teriparatide and denosumab treatment for pregnancy and lactation-associated osteoporosis with multiple vertebral fractures: A case study. Taiwan J. Obstet. Gynecol. 56(6), 863–866 (2017)
pubmed: 29241936
doi: 10.1016/j.tjog.2017.10.028
O. Loukadaki, S. Tournis, S. Gazi, Clinical Case: Pregnancy lactation osteoporosis. Mediterranean J. Rheumatol. 28(3), 161–163 (2017)
doi: 10.31138/mjr.28.3.161
E. Pola et al. Pregnancy-associated osteoporosis (PAO) with multiple vertebral fragility fractures: diagnosis and treatment in a young primigravid woman. J. Biol. Regul. Homeost. Agents 30(4 Suppl 1), 153–158 (2016)
pubmed: 28002913
S.B. Polat et al. Effective treatment of severe pregnancy and lactation-related osteoporosis with teriparatide: case report and review of the literature. Gynecol. Endocrinol. 31(7), 522–525 (2015)
pubmed: 25893268
doi: 10.3109/09513590.2015.1014787
S. Hadgaonkar et al. Post pregnancy severe spinal osteoporosis with multiple vertebral fractures and kyphoscoliosis in a multigravida: A rare case with management. Asian Spine J. 9(4), 625 (2015)
pubmed: 26240726
pmcid: 4522457
doi: 10.4184/asj.2015.9.4.625
I. Coskun Benlidayi, T. Sarpel, R. Guzel, Short-term treatment experience with teriparatide in pregnancy- and lactation-associated osteoporosis. J. Obstet. Gynaecol. 34(8), 736–736 (2014)
pubmed: 24911426
doi: 10.3109/01443615.2014.920800
N. Takahashi et al. Four-year follow-up of pregnancy-associated osteoporosis: a case report. Fukushima J. Med. Sci. 60(2), 175–180 (2014)
pubmed: 25283976
doi: 10.5387/fms.2014-14
S.H. Lee et al. A case of teriparatide on pregnancy-induced osteoporosis. J. Bone Metab. 20(2), 111 (2013)
pubmed: 24524067
pmcid: 3910313
doi: 10.11005/jbm.2013.20.2.111
K. Lampropoulou-Adamidou et al. Case report: teriparatide treatment in a case of severe pregnancy-and lactation-associated osteoporosis. Hormones 11, 495–500 (2012)
pubmed: 23422774
doi: 10.14310/horm.2002.1383