title: Effect of teriparatide on pregnancy and lactation-associated osteoporosis with multiple vertebral fractures.
abstract: Pregnancy and lactation-associated osteoporosis (PLO) is very rare, but it can cause severe vertebral compression fractures with disabling back pain. PLO patients have commonly been treated with antiresorptive agents against high bone turnover. There are, however, some concerns regarding the use of bisphosphonates: (1) PLO occurs during the first pregnancy with a high possibility of recurrence during the second pregnancy, (2) long-term outcomes of bisphosphonates in PLO are lacking, and (3) there is a possibility of bisphosphonates accumulated in the bones crossing the placenta. Therefore, alternative therapies must be considered. We analyzed the effect of teriparatide (TPTD), the human recombinant parathyroid hormone (1-34), for 18 months in three women with PLO. Multiple vertebral fractures with severe back pain appeared within 6 months after their first childbirth. Two of them had a family history of osteoporosis. Lactation was discontinued immediately after diagnosis of PLO. Calcium carbonate, cholecalciferol, and TPTD were prescribed. The back pain immediately resolved. Bone mineral density (BMD) increased by 14.5-25.0% (mean 19.5%) at the lumbar spine and by 9.5-16.7% (mean 13.1%) at the femoral neck, after 18 months of treatment. The final Z scores in these PLO patients were nearly normalized. Two women had a second baby without any complication. BMD significantly improved after 18 months of treatment with TPTD without further fractures. In conclusion, TPTD should be considered to avoid long-term morbidity in young patients with PLO and is highly encouraged for use in PLO patients with multiple vertebral fractures.
authors: Department of Internal Medicine, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
authors: Eun Yeong
authors: EY
authors: Choe
authors: Je Eun
authors: JE
authors: Song
authors: Kyeong Hye
authors: KH
authors: Park
authors: Hannah
authors: H
authors: Seok
authors: Eun Jig
authors: EJ
authors: Lee
authors: Sung-Kil
authors: SK
authors: Lim
authors: Yumie
authors: Y
authors: Rhee
mesh_terms: D000328:Adult; D001416:Back Pain / Q000209:etiology; D015519:Bone Density / Q000187:drug effects; D002119:Calcium Carbonate / Q000627:therapeutic use; D002762:Cholecalciferol / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects; D005260:Female; D005272:Femur Neck / Q000187:drug effects; D050815:Fractures, Compression / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007774:Lactation / Q000502:physiology*; D010024:Osteoporosis / Q000188:drug therapy* / Q000473:pathology; D010281:Parathyroid Hormone / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000473:pathology; D016103:Spinal Fractures / Q000188:drug therapy* / Q000473:pathology; D019379:Teriparatide / Q000627:therapeutic use*
chemical_list: D004164:Diphosphonates; C470125:PTH protein, human; D010281:Parathyroid Hormone; D019379:Teriparatide; D002762:Cholecalciferol; D002119:Calcium Carbonate