Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis
Early diagnosis of pregnancy- and lactation-associated osteoporosis (PLO) is mandatory for a good outcome. Standard care is not a matter of conventional guidelines, rather it requires an individualized strategy while true overall incidence and pathogeny remain open issues. This is a narrative review...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-05-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/9/1615 |
| _version_ | 1797602799728459776 |
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| author | Mara Carsote Maria Roxana Turturea Ana Valea Cristian Buescu Claudiu Nistor Ionut Florin Turturea |
| author_facet | Mara Carsote Maria Roxana Turturea Ana Valea Cristian Buescu Claudiu Nistor Ionut Florin Turturea |
| author_sort | Mara Carsote |
| collection | DOAJ |
| description | Early diagnosis of pregnancy- and lactation-associated osteoporosis (PLO) is mandatory for a good outcome. Standard care is not a matter of conventional guidelines, rather it requires an individualized strategy while true overall incidence and pathogeny remain open issues. This is a narrative review based on full-length English articles, published between January 2021 and March 2023 and accessed via PubMed (no traumatic fractures or secondary osteoporosis are included). Our case-sample-based analysis included 836 females with PLO (the largest cohort based on published cases so far) through 12 studies and 24 single case reports. Except for one survey, these involved retrospective cohorts of small size (6–10 females/study) to medium size (23–47 women/study), and large cohorts with >50 subjects per study (a maximum of 379). Age of diagnosis: from 24 to 40 years for case reports (most subjects being over 30 and primigravida), while original studies indicated an average age between 31 and 34.18 years. Type of fractures underlined a most frequent vertebral phenotype (a mean of 2 to 5.8 vertebral fractures per patient) versus a most severe non-vertebral phenotype (hip and femoral neck fractures mostly requiring surgery). Potential contributors varied: smoking (1/3–1/2 of subjects), family history of osteoporosis (1/3), heparin and glucocorticoid use in pregnancy, low body mass index (majority of cases), hypovitaminosis D; and (with a low level of statistical significance) anti-psychotic medication, gestational diabetes, lupus, thrombophilia, anemia, in vitro fertilization (1/3 in one study), twin pregnancy, tocolysis with MgSO4, and postpartum thyroiditis. Most remarkably, up to 50% of PLO patients harbor mutations of <i>LRP5, WNT1</i>, and <i>COL1A1/A2</i> (more damaged form with potential benefits from osteoanabolic drugs); gene testing might become the new norm in PLO. The low index of clinical suspicion should be supported by performing magnetic resonance imaging (gold standard in pregnancy) with DXA (in lactation). Low bone mineral density is expected (Z-score varying from −2.2 SD to −4 SD, unless normal which does not exclude PLO). Bone turnover markers might be useful in individuals with normal DXA, in pregnancy when DXA cannot be performed, and in following the response to anti-osteoporosis drugs. Alternatively, microarchitecture damage might be reflected by DXA-trabecular bone score and high-resolution peripheral quantitative computed tomography. Specific medical interventions are currently focused on teriparatide (TPT) use (3 studies; <i>n</i> = 99 females treated with TPT and an additional subgroup of 18 patients from the gene-analysis-based study, thus a total of 117 females) which seems to be the therapy of choice as reflected by these new data: 6–24 months, 20 µg/day, no sequential therapy needed; case selection based on high fracture risk is necessary). The first case using romosozumab was reported in 2022. PAO/LAO remains a challenging condition which is a battle for the wellbeing of two individuals, on one hand, considering maternal-fetal outcomes and taking care of the offspring, but it is a battle for a multidisciplinary team, on the other hand, since a standardized approach is lacking. |
| first_indexed | 2024-03-11T04:21:37Z |
| format | Article |
| id | doaj.art-dc07a51046944d41b02902cfb1b35eab |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T04:21:37Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-dc07a51046944d41b02902cfb1b35eab2023-11-17T22:46:06ZengMDPI AGDiagnostics2075-44182023-05-01139161510.3390/diagnostics13091615Bridging the Gap: Pregnancy—And Lactation—Associated OsteoporosisMara Carsote0Maria Roxana Turturea1Ana Valea2Cristian Buescu3Claudiu Nistor4Ionut Florin Turturea5Department of Endocrinology, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, 011683 Bucharest, RomaniaDepartment of Endocrinology, Dej City Hospital, 405200 Dej, RomaniaDepartment of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy & Clinical County Hospital, 400347 Cluj-Napoca, RomaniaDepartment of Orthopedics and Traumatology, Cluj Emergency County Hospital, 400347 Cluj-Napoca, RomaniaDepartment 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Carol Davila University of Medicine and Pharmacy & Thoracic Surgery Department, Dr. Carol Davila Central Emergency University Military Hospital, 011683 Bucharest, RomaniaDepartment of Orthopedics and Traumatology, Cluj Emergency County Hospital, 400347 Cluj-Napoca, RomaniaEarly diagnosis of pregnancy- and lactation-associated osteoporosis (PLO) is mandatory for a good outcome. Standard care is not a matter of conventional guidelines, rather it requires an individualized strategy while true overall incidence and pathogeny remain open issues. This is a narrative review based on full-length English articles, published between January 2021 and March 2023 and accessed via PubMed (no traumatic fractures or secondary osteoporosis are included). Our case-sample-based analysis included 836 females with PLO (the largest cohort based on published cases so far) through 12 studies and 24 single case reports. Except for one survey, these involved retrospective cohorts of small size (6–10 females/study) to medium size (23–47 women/study), and large cohorts with >50 subjects per study (a maximum of 379). Age of diagnosis: from 24 to 40 years for case reports (most subjects being over 30 and primigravida), while original studies indicated an average age between 31 and 34.18 years. Type of fractures underlined a most frequent vertebral phenotype (a mean of 2 to 5.8 vertebral fractures per patient) versus a most severe non-vertebral phenotype (hip and femoral neck fractures mostly requiring surgery). Potential contributors varied: smoking (1/3–1/2 of subjects), family history of osteoporosis (1/3), heparin and glucocorticoid use in pregnancy, low body mass index (majority of cases), hypovitaminosis D; and (with a low level of statistical significance) anti-psychotic medication, gestational diabetes, lupus, thrombophilia, anemia, in vitro fertilization (1/3 in one study), twin pregnancy, tocolysis with MgSO4, and postpartum thyroiditis. Most remarkably, up to 50% of PLO patients harbor mutations of <i>LRP5, WNT1</i>, and <i>COL1A1/A2</i> (more damaged form with potential benefits from osteoanabolic drugs); gene testing might become the new norm in PLO. The low index of clinical suspicion should be supported by performing magnetic resonance imaging (gold standard in pregnancy) with DXA (in lactation). Low bone mineral density is expected (Z-score varying from −2.2 SD to −4 SD, unless normal which does not exclude PLO). Bone turnover markers might be useful in individuals with normal DXA, in pregnancy when DXA cannot be performed, and in following the response to anti-osteoporosis drugs. Alternatively, microarchitecture damage might be reflected by DXA-trabecular bone score and high-resolution peripheral quantitative computed tomography. Specific medical interventions are currently focused on teriparatide (TPT) use (3 studies; <i>n</i> = 99 females treated with TPT and an additional subgroup of 18 patients from the gene-analysis-based study, thus a total of 117 females) which seems to be the therapy of choice as reflected by these new data: 6–24 months, 20 µg/day, no sequential therapy needed; case selection based on high fracture risk is necessary). The first case using romosozumab was reported in 2022. PAO/LAO remains a challenging condition which is a battle for the wellbeing of two individuals, on one hand, considering maternal-fetal outcomes and taking care of the offspring, but it is a battle for a multidisciplinary team, on the other hand, since a standardized approach is lacking.https://www.mdpi.com/2075-4418/13/9/1615fractureosteoporosiscalciumpregnancylactationhip |
| spellingShingle | Mara Carsote Maria Roxana Turturea Ana Valea Cristian Buescu Claudiu Nistor Ionut Florin Turturea Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis Diagnostics fracture osteoporosis calcium pregnancy lactation hip |
| title | Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis |
| title_full | Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis |
| title_fullStr | Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis |
| title_full_unstemmed | Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis |
| title_short | Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis |
| title_sort | bridging the gap pregnancy and lactation associated osteoporosis |
| topic | fracture osteoporosis calcium pregnancy lactation hip |
| url | https://www.mdpi.com/2075-4418/13/9/1615 |
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