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Pregnancy-related fractures: a retrospective study of a French cohort of 52 patients and review of the literature

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Abstract

Summary

A retrospective, multicentre study involving 52 patients was carried out to define the causes and characteristics of pregnancy-related osteoporosis. The mean number of vertebral fractures occurring during the last trimester of pregnancy or at the time of delivery was 3.8. This is often promoted by risk factors before or during pregnancy.

Introduction

In order to define the causes or predisposing factors of pregnancy-related osteoporosis and its clinical, radiological and bone density characteristics, laboratory findings, course and outcome, we carried out a retrospective multicentre study.

Methods

The records of 52 women hospitalised over the last 10 years in the rheumatology departments of six French university hospitals and with a diagnosis of pregnancy-related osteoporosis were examined.

Results

The patients’ mean age at time of fracture was 32.1 years. In 10 patients, the fractures had occurred during the last trimester of pregnancy, and in 36 at the time of delivery or during the first 2 months post-partum. The mean number of vertebral fractures was 3.8 ± 2.0. Thirty three of the 52 patients had a risk factor of low bone mass before pregnancy. Twelve had disorders or treatments (heparin) that might promote osteoporosis during pregnancy, while 14 had no trigger factors before or during pregnancy. Overall, phosphate and calcium levels were normal, except for hyperphosphoraemia in lactating women (90%). On DXA scan, osteoporosis predominated in the trabecular bone (spinal T-score − 3.4, hip T-score − 2). Only 10 patients had a repeat fracture, and the increase in bone mineral density during follow-up was considerable, and improved by bisphosphonates (annual gain + 10% in the spine) or teriparatide (+ 15%).

Conclusions

Pregnancy-related osteoporosis gives rise to multiple vertebral fractures. It is often promoted by risk factors before or during pregnancy. Its mechanism is still unknown. Treatment with bisphosphonates or teriparatide appears to improve the recovery of bone mineral density.

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References

  1. Arikaya S, Ozdolap S, Açikgöz G, Erdem CZ (2004) Pregnancy-associated osteoporosis with vertebral fractures and scoliosis. Joint Bone Spine 71:84–85

    Article  Google Scholar 

  2. Ozturk C, Atamaz FC, Akkurt H, Akkoc Y (2014) Pregnancy-associated osteoporosis presenting severe vertebral fractures. J Obstet Gynaecol Res 40:288–292

    Article  CAS  PubMed  Google Scholar 

  3. Saraux A, Bourgeais F, Ehrhart A, Baron D, Le Goff P (1993) Osteoporosis during pregnancy. 4 cases. Rev Rhum 60:596–600

    CAS  Google Scholar 

  4. Smith R, Stevenson JC, Winearls CG, Woods CG, Wordsworth BP (1985) Osteoporosis of pregnancy. Lancet 8439:1178–1180

    Article  Google Scholar 

  5. Smith R, Athanasou NA, Ostlere SJ, Vipond SE (1995) Pregnancy-associated osteoporosis. QJM 88:865–878

    CAS  PubMed  Google Scholar 

  6. Dunne F, Walters B, Marshall T, Heath DA (1993) Pregnancy associated osteoporosis. Clin Endocrinol 39:487–490

    Article  CAS  Google Scholar 

  7. Karlsson MK, Ahlborg HG, Karlsson C (2005) Pregnancy and lactation are not risk factors for osteoporosis or fractures. Lakartidningen 102:290–293

    PubMed  Google Scholar 

  8. Karlsson C, Obrant KJ, Karlsson M (2001) Pregnancy and lactation confer reversible bone loss in humans. Osteoporos Int 12:828–835

    Article  CAS  PubMed  Google Scholar 

  9. Kaur M, Pearson D, Godber I, Lawson N, Baker P, Hosking D (2003) Longitudinal changes in bone mineral density during normal pregnancy. Bone 32:449–454

    Article  CAS  PubMed  Google Scholar 

  10. Cross NA, Hillman LS, Allen SH, Krause GF, Vieira NE (1995) Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. Am J Clin Nutr 61:514–523

    CAS  PubMed  Google Scholar 

  11. Kohlmeier L, Marcus R (1995) Calcium disorders of pregnancy. Endocrinol Metab Clin N Am 24:15–39

    CAS  Google Scholar 

  12. Møller UK, Streym S, Mosekilde L, Heickendorff L, Flyvbjerg A, Frystyk J, Jensen LT, Rejnmark L (2013) Changes in calcitropic hormones, bone markers and insulin-like growth factor I (IGF-I) during pregnancy and postpartum: a controlled cohort study. Osteoporos Int 24:1307–1320

    Article  PubMed  Google Scholar 

  13. Anai T, Tomiyasu T, Arima K, Miyakawa I (1999) Pregnancy-associated osteoporosis with elevated levels of circulating parathyroid hormone-related protein: a report of two cases. J Obstet Gynaecol Res 25:63–67

    Article  CAS  PubMed  Google Scholar 

  14. Bonacker J, Janousek M, Kröber M (2014) Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report. Arch Orthop Trauma Surg 134:173–179

    Article  CAS  PubMed  Google Scholar 

  15. Phillips AJ, Ostlere SJ, Smith R (2000) Pregnancy-associated osteoporosis: does the skeleton recover? Osteoporos Int 11:449–454

    Article  CAS  PubMed  Google Scholar 

  16. Jang JY, Lee JG, Jeong IK, Ahn KJ, Chung HY, Yang HI, Lee SH (2009) A case of post-pregnancy osteoporosis combined with ankylosing spondylitis. Rheumatol Int 29:1359–1362

    Article  PubMed  Google Scholar 

  17. Allali F, Guedirra N, Hajjaj-Hassouni N (2005) A case of post-pregnancy osteoporosis-related spinal fractures in association with ankylosing spondylitis. Clin Rheumatol 24:435–436

    Article  PubMed  Google Scholar 

  18. Ofluoglu O, Ofluoglu D (2008) A case report: pregnancy-induced severe osteoporosis with eight vertebral fractures. Rheumatol Int 29:197–201

    Article  PubMed  Google Scholar 

  19. Yamamoto N, Takahashi HE, Tanizawa T, Kawashima T, Endo N (1994) Bone mineral density and bone histomorphometric assessments of postpregnancy osteoporosis: a report of five patients. Calcif Tissue Int 54:20–25

    Article  CAS  PubMed  Google Scholar 

  20. Iwamoto J, Sato Y, Uzawa M, Matsumoto H (2012) Five-year follow-up of a woman with pregnancy and lactation-associated osteoporosis and vertebral fractures. Ther Clin Risk Manag 8:195–199

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Rillo OL, Di Stefano CA, Bermudez J, Maldonado Cocco JA (2012) Idiopathic osteoporosis during pregnancy. Clin Rheumatol 13:299–304

    Article  Google Scholar 

  22. Breuil V, Brocq O, Euller-Ziegler L, Grimaud A (1997) Insufficiency fracture of the sacrum revealing a pregnancy associated osteoporosis. First case report. Ann Rheum Dis 56:278–279

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Monigel H, Stoll D, Aubry-Rozier B, Fetz GL, Theumann N, Lamy O (2012) Non-traumatic fractures at the end of a pregnancy: are there always of osteoporotic origin ? Praxis 101:923–928

    Article  CAS  PubMed  Google Scholar 

  24. Gruber HE, Gutteridge DH, Baylink DJ (1984) Osteoporosis associated with pregnancy and lactation: bone biopsy and skeletal features in three patients. Metab Bone Dis Relat Res 5:159–165

    Article  CAS  PubMed  Google Scholar 

  25. Vandecandelaere M, Cortet B, Flipo RM, Duquesnoy B, Delcambre B (1997) Osteoporosis in pregnancy: a propos of 2 cases. Article in French. Rev Med Interne 18:571–574

    Article  CAS  PubMed  Google Scholar 

  26. Raffaetà G, Mazzantini M, Menconi A, Bottai V, Falossi F, Celauro I, Guido G (2014) Osteoporosis with vertebral fractures associated with pregnancy: two case reports. Clin Cases Miner Bone Metab 11:136–138

    PubMed  PubMed Central  Google Scholar 

  27. Campos-Obando N, Oei L, Hoefsloot LH, Kiewiet RM, Klaver CC, Simon ME, Zillikens MC (2014) Osteoporotic vertebral fractures during pregnancy: be aware of a potential underlying genetic cause. J Clin Endocrinol Metab 99:1107–1111

    Article  CAS  PubMed  Google Scholar 

  28. Ozcelik B, Ozcelik A, Debre M (2009) Postpartum depression co-occurring with lactation-related osteoporosis. Psychosomatics 50:155–158

    Article  CAS  PubMed  Google Scholar 

  29. Ozdemir D, Tam AA, Dirikoc A, Ersoy R, Cakir B (2014) Postpartum osteoporosis and vertebral fractures in two patients treated with enoxaparin during pregnancy. Osteoporos Int 26:415–418

    Article  PubMed  Google Scholar 

  30. Clemetson IA, Popp A, Lippuner K, Ballmer F, Anderson SE (2004) Postpartum osteoporosis associated with proximal tibial stress fracture. Skelet Radiol 33:96–98

    Article  CAS  Google Scholar 

  31. Lin JT, Lutz GE (2004) Postpartum sacral fracture presenting as lumbar radiculopathy: a case report. Arch Phys Med Rehabil 85:1358–1361

    Article  PubMed  Google Scholar 

  32. Park J, Ok E, Park HJ, Hong SH, Lee JI (2013) Postpartum sacral stress fracture mimicking lumbar radiculopathy in a patient with pregnancy-associated osteoporosis. Ann Rehabil Med 37:582–585

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tabache F, el Maghraoui A, Bezza A, Abouzahir A, Ghafir D, Ohayon V, Archane MI (2002) Post-pregnancy osteoporosis. A case report. Article in French. Rev Med Interne 23:99–100

    Article  CAS  PubMed  Google Scholar 

  34. Reid IR, Wattie DJ, Evans MC, Budayr AA (1992) Post-pregnancy osteoporosis associated with hypercalcaemia. Clin Endocrinol 37:298–303

    Article  CAS  Google Scholar 

  35. Tanriover MD, Oz SG, Sozen T, Kilicarslan A, Guven GS (2009) Pregnancy- and lactation-associated osteoporosis with severe vertebral deformities: can strontium ranelate be a new alternative for the treatment? Spine 9:e20–e24

    Article  Google Scholar 

  36. Kabi F, Mkinsi O, Zrigui J (2006) Pregnancy-associated osteoporosis. A new case. Article in French. Rev Med Interne 27:558–560

    Article  CAS  PubMed  Google Scholar 

  37. Stumpf UC, Kurth AA, Windolf J, Fassbender WJ (2007) Pregnancy-associated osteoporosis: an underestimated and underdiagnosed severe disease. A review of two cases in short- and long-term follow-up. Adv Med Sci 52:94–97

    CAS  PubMed  Google Scholar 

  38. Liel Y, Atar D, Ohana N (1998) Pregnancy-associated osteoporosis: preliminary densitometric evidence of extremely rapid recovery of bone mineral density. South Med J 91:33–35

    Article  CAS  PubMed  Google Scholar 

  39. Blanch J, Pacifici R, Chines A (1994) Pregnancy-associated osteoporosis: report of two cases with long-term bone density follow-up. Br J Rheumatol 33:269–272

    Article  CAS  PubMed  Google Scholar 

  40. Cook FJ, Mumm S, Whyte MP, Wenkert D (2014) Pregnancy-associated osteoporosis with a heterozygous deactivating LDL receptor-related protein 5 (LRP5) mutation and a homozygous methylenetetrahydrofolate reductase (MTHFR) polymorphism. J Bone Miner Res 29:922–928

    Article  CAS  PubMed  Google Scholar 

  41. Segal E, Hochberg I, Weisman Y, Ish-Shalom S (2011) Severe postpartum osteoporosis with increased PTHrP during lactation in a patient after total thyroidectomy and parathyroidectomy. Osteoporos Int 22:2907–2911

    Article  CAS  PubMed  Google Scholar 

  42. Hellmeyer L, Boekhoff J, Hadji P (2010) Treatment with teriparatide in a patient with pregnancy-associated osteoporosis. Gynecol Endocrinol 26:725–728

    Article  CAS  PubMed  Google Scholar 

  43. Hellmeyer L, Kühnert M, Ziller V, Schmidt S, Hadji P (2007) The use of I V. Bisphosphonate in pregnancy-associated osteoporosis—case study. Exp Clin Endocrinol Diabetes 115:139–142

    Article  CAS  PubMed  Google Scholar 

  44. Tran HA, Petrovsky N (2002) Pregnancy-associated osteoporosis with hypercalcaemia. Intern Med J 32:481–488

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Rheumatology, Toulouse University Hospital, Toulouse, France

    M. Laroche, M. Talibart & Y. Degboe

  2. Centre de Rhumatologie, Hôpital Pierre Paul Riquet, CHU Purpan, 1 place du Dr Baylac, 31059, Toulouse Cedex, France

    M. Laroche

  3. Department of Rheumatology, Cochin University Hospital, Paris, France

    C. Cormier & C. Roux

  4. Department of Rheumatology, Rennes University Hospital, Amiens, France

    P. Guggenbuhl

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  1. M. Laroche
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Correspondence to M. Laroche.

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Laroche, M., Talibart, M., Cormier, C. et al. Pregnancy-related fractures: a retrospective study of a French cohort of 52 patients and review of the literature. Osteoporos Int 28, 3135–3142 (2017). https://doi.org/10.1007/s00198-017-4165-2

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  • DOI: https://doi.org/10.1007/s00198-017-4165-2

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