Top

Osteoporosis International

Published in:

01-11-2017 | Original Article

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

Authors: M. Laroche, M. Talibart, C. Cormier, C. Roux, P. Guggenbuhl, Y. Degboe

Published in: Osteoporosis International | Issue 11/2017

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.

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

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

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

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

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

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

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

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

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

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 61:514–523PubMed

11.

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

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 24:1307–1320CrossRefPubMed

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 25:63–67CrossRefPubMed

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 134:173–179CrossRefPubMed

15.

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

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 29:1359–1362CrossRefPubMed

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 24:435–436CrossRefPubMed

18.

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

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 54:20–25CrossRefPubMed

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 8:195–199CrossRefPubMedPubMedCentral

21.

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

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 56:278–279CrossRefPubMedPubMedCentral

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 101:923–928CrossRefPubMed

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 5:159–165CrossRefPubMed

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 18:571–574CrossRefPubMed

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 11:136–138PubMedPubMedCentral

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 99:1107–1111CrossRefPubMed

28.

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

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 26:415–418CrossRefPubMed

30.

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

31.

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

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 37:582–585CrossRefPubMedPubMedCentral

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 23:99–100CrossRefPubMed

34.

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

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–e24CrossRef

36.

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

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 52:94–97PubMed

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 91:33–35CrossRefPubMed

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 33:269–272CrossRefPubMed

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 29:922–928CrossRefPubMed

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 22:2907–2911CrossRefPubMed

42.

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

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 115:139–142CrossRefPubMed

44.

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

Title: Pregnancy-related fractures: a retrospective study of a French cohort of 52 patients and review of the literature
Authors: M. Laroche
M. Talibart
C. Cormier
C. Roux
P. Guggenbuhl
Y. Degboe
Publication date: 01-11-2017
Publisher: Springer London
Published in: Osteoporosis International / Issue 11/2017
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-017-4165-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2017

24-hour profile of serum sclerostin and its association with bone biomarkers in men

Atypical femur fractures: a survey of current practices in orthopedic surgery

Correction of vitamin D status by calcidiol: pharmacokinetic profile, safety, and biochemical effects on bone and mineral metabolism of daily and weekly dosage regimens

Patterns of alcohol consumption and risk of falls in older adults: a prospective cohort study

Children and adolescents with cystic fibrosis display moderate bone microarchitecture abnormalities: data from high-resolution peripheral quantitative computed tomography

Interventions for humeral shaft fractures: mixed treatment comparisons of clinical trials