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Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2021

01-12-2021 | Bisphosphonate | Case Report

Malleolar fracture in pregnancy and lactation-associated osteoporosis: a case report and literature review

Authors: Xiaodong Bai, Gang Wang, Guoqiang Xu, Baojun Wang

Published in: Archives of Osteoporosis | Issue 1/2021

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Abstract

Objective

The incidence of fractures in pregnancy and lactation-associated osteoporosis (PLO) is very low. Some fracture cases of PLO are associated with vertebral compression fractures, while malleolar fractures in patients with PLO are rarely reported before.

Case report

A 31-year-old Han Chinese patient presented with a malleolar fracture 3 months after delivery, while she was still breastfeeding. Temporary closed reduction and plaster external fixation were performed in the emergency room. Then the patient was admitted to the orthopedic trauma ward for surgery and diagnosed as PLO by dual-energy X-ray absorptiometry (DEXA). After preoperative evaluation, the patient underwent open reduction and internal fixation. With the diagnosis of PLO, the patient was treated with weaning, bisphosphonate, and supplementation of calcium carbonate and vitamin D. During the 12-month follow-up period, the results of DEXA and laboratory examination improved gradually, and the internal fixation was removed 12 months after surgery.

Conclusion

Orthopedic doctors should not ignore the possibility of PLO to avoid misdiagnosis of perinatal women with fractures. Improvement of functional recovery of fractures can be achieved with accurate diagnosis and individual treatment.
Literature
1.
Kanis JA, Cooper C, Rizzoli R et al (2020) Correction to: European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 31(1):209CrossRef
2.
Gehlen M, Lazarescu AD, Hinz C, Boncu B, Schmidt N, Pfeifer M, Schwarz-Eywill M, Pollähne W, Minne HW (2017) Pregnancy and lactation-associated osteoporosis. Z Rheumatol 76(3):274–278CrossRef
3.
Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I (2017) Pregnancy-associated transient osteoporosis of the hip: results of a case-control study. Arch Osteoporos 12(1):11CrossRef
4.
Ferrari S, Bianchi ML, Eisman JA et al (2012) Osteoporosis in young adults: pathophysiology, diagnosis, and management. Osteoporos Int 23(12):2735–2748CrossRef
5.
Kuroda T, Nagai T, Ishikawa K, Inagaki K (2019) Clinical features and diagnosis of lumbar fractures caused by pregnancy- and lactation-associated osteoporosis. Clin Calcium 29(1):46–50PubMed
6.
Ozturk G, Akpinar P, Karamanlioglu AD, Ozkan FU, Aktas I (2018) Pregnancy-related osteoporotic vertebral compression fractures in two patients treated with low-molecular-weight heparin during pregnancy: case reports. Gynecol Endocrinol 34(5):378–380CrossRef
7.
Yun KY, Han SE, Kim SC, Joo JK, Lee KS (2017) Pregnancy-related osteoporosis and spinal fractures. Obstet Gynecol Sci 60(1):133–137CrossRef
8.
Nordin BE, Roper A (1955) Post-pregnancy osteoporosis; a syndrome? Lancet 268(6861):431–434CrossRef
9.
Yang B, Kong L, Hao D (2020) Challenges in the management of pregnancy and lactation associated osteoporosis: literature review and retrospective study. Curr Stem Cell Res Ther
10.
Hellmeyer LHPZV (2004) Osteoporose in der Schwangerschaft. Geburtshilfe Frauenheilkd 64:38–45CrossRef
11.
Cohen A, Kamanda-Kosseh M, Dempster DW, Zhou H, Müller R, Goff E, Colon I, Bucovsky M, Stubby J, Nickolas TL, Stein EM, Recker RR, Lappe JM, Shane E (2019) Women with pregnancy and lactation-associated osteoporosis (PLO) have low bone remodeling rates at the tissue level [J]. J Bone Miner Res 34(9):1552–1561CrossRef
12.
Cerit ET, Cerit M (2020) A case of pregnancy and lactation associated osteoporosis in the third pregnancy; robust response to teriparatide despite delayed administration. Bone Rep 13:100706CrossRef
13.
Kyvernitakis I, Reuter TC, Hellmeyer L, Hars O, Hadji P (2018) Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up. Osteoporos Int 29(1):135–142CrossRef
14.
Kovacs CS, Ralston SH (2015) Presentation and management of osteoporosis presenting in association with pregnancy or lactation. Osteoporos Int 26(9):2223–2241CrossRef
15.
Kovacs CS (2014) Bone development and mineral homeostasis in the fetus and neonate: roles of the calciotropic and phosphotropic hormones. Physiol Rev 94(4):1143–1218CrossRef
16.
Kovacs CS (2016) Maternal mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery. Physiol Rev 96(2):449–547CrossRef
17.
Winter EM, Appelman-Dijkstra NM (2017) Parathyroid hormone-related protein-induced hypercalcemia of pregnancy successfully reversed by a dopamine agonist. J Clin Endocrinol Metab 102(12):4417–4420CrossRef
18.
Ardawi MS, Nasrat HA, BA’Aqueel HS (1997) Calcium-regulating hormones and parathyroid hormone-related peptide in normal human pregnancy and postpartum: a longitudinal study. Eur J Endocrinol 137(4):402–409CrossRef
19.
Kovacs CS, Kronenberg HM (1997) Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation. Endocr Rev 18(6):832–872PubMed
20.
Peris P, Guanabens N, Monegal A et al (2002) Pregnancy associated osteoporosis: the familial effect. Clin Exp Rheumatol 20(5):697–700PubMed
21.
Dunne F, Walters B, Marshall T, Heath DA (1993) Pregnancy associated osteoporosis. Clin Endocrinol (Oxf) 39(4):487–490CrossRef
22.
Butscheidt S, Delsmann A, Rolvien T, Barvencik F, al-Bughaili M, Mundlos S, Schinke T, Amling M, Kornak U, Oheim R (2018) Mutational analysis uncovers monogenic bone disorders in women with pregnancy-associated osteoporosis: three novel mutations in LRP5, COL1A1, and COL1A2. Osteoporos Int 29(7):1643–1651CrossRef
23.
Collet C, Ostertag A, Ricquebourg M, Delecourt M, Tueur G, Isidor B, Guillot P, Schaefer E, Javier RM, Funck-Brentano T, Orcel P, Laplanche JL, Cohen-Solal M (2018) Primary osteoporosis in young adults: genetic basis and identification of novel variants in causal genes. JBMR Plus 2(1):12–21CrossRef
24.
Winter EM, Ireland A, Butterfield NC, Haffner-Luntzer M, Horcajada MN, Veldhuis-Vlug AG, Oei L, Colaianni G, Bonnet N (2020) Pregnancy and lactation, a challenge for the skeleton. Endocr Connect 9(6):R143–R157CrossRef
25.
O'Sullivan SM, Grey AB, Singh R et al (2006) Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int 17(7):1008–1012CrossRef
26.
Hassen-Zrour S, Korbaa W, Bejia I et al (2010) Maternal and fetal outcome after long-term bisphosphonate exposure before conception. Osteoporos Int 21(4):709–710CrossRef
27.
Jia P, Wang R, Yuan J, Chen H, Bao L, Feng F, Tang H (2020) A case of pregnancy and lactation-associated osteoporosis and a review of the literature. Arch Osteoporos 15(1):94CrossRef
28.
Li LJ, Zhang J, Gao P, Lv F, Song YW, Chang XY, Zhao DC, Wang O, Jiang Y, Xing XP, Xia WB, Li M (2018) Clinical characteristics and bisphosphonates treatment of rare pregnancy- and lactation-associated osteoporosis. Clin Rheumatol 37(11):3141–3150CrossRef
29.
Gaudio A, Fiore CE (2016) Successful neridronate therapy in pregnancy-associated osteoporosis. Clin Cases Miner Bone Metab 13(3):241–243PubMed
30.
Cohen A (2010) Should bisphosphonates be used in premenopausal women? Maturitas 66(1):3–4CrossRef
31.
Choe EY, Song JE, Park KH, Seok H, Lee EJ, Lim SK, Rhee Y (2012) Effect of teriparatide on pregnancy and lactation-associated osteoporosis with multiple vertebral fractures. J Bone Miner Metab 30(5):596–601CrossRef
32.
Coskun BI, Sarpel T, Guzel R (2014) Short-term treatment experience with teriparatide in pregnancy- and lactation-associated osteoporosis. J Obstet Gynaecol 34(8):736CrossRef
33.
Quattrocchi E, Kourlas H (2004) Teriparatide: a review. Clin Ther 26(6):841–854CrossRef
34.
Hong N, Kim JE, Lee SJ, Kim SH, Rhee Y (2018) Changes in bone mineral density and bone turnover markers during treatment with teriparatide in pregnancy- and lactation-associated osteoporosis. Clin Endocrinol (Oxf) 88(5):652–658CrossRef
35.
Ijuin A, Yoshikata H, Asano R, Tsuburai T, Kikuchi R, Sakakibara H (2017) Teriparatide and denosumab treatment for pregnancy and lactation-associated osteoporosis with multiple vertebral fractures: a case study. Taiwan J Obstet Gynecol 56(6):863–866CrossRef
36.
Gilsenan A, Midkiff K, Harris D, Kellier-Steele N, McSorley D, Andrews EB (2020) Teriparatide did not increase adult osteosarcoma incidence in a 15-year us postmarketing surveillance study. J Bone Miner Res
37.
Phillips AJ, Ostlere SJ, Smith R (2000) Pregnancy-associated osteoporosis: does the skeleton recover? Osteoporos Int 11(5):449–454CrossRef
38.
Carter TH, Duckworth AD, White TO (2019) Medial malleolar fractures: current treatment concepts. Bone Joint J 101-B(5):512–521CrossRef
Metadata
Title
Malleolar fracture in pregnancy and lactation-associated osteoporosis: a case report and literature review
Authors
Xiaodong Bai
Gang Wang
Guoqiang Xu
Baojun Wang
Publication date
01-12-2021
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-021-00908-7

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