title: Successful treatment of 1-34 parathyroid hormone (PTH) after failure of bisphosphonate therapy in a complex case of pregnancy associated osteoporosis and multiple fractures.
abstract: BACKGROUND
  Pregnancy associated osteoporosis (PAO) was first reported almost half a century ago. The most common symptom is acute lower back pain due to vertebral fractures in the last trimester or immediately after birth.
  
  
  METHODS
  We present a case involving a female patient born in 1971 (gravida II, para I) with a history of PAO. In April 2000 at the age of 28 years, she delivered a son and breastfed him for 4 months. A first magnetic resonance tomography (MRT) screening in June 2000 showed osteoporotic fractures at lumbar vertebra 1-4. Therefore, the patient received oral alendronate therapy. In May 2001, a second MRT exhibited burst fracture of thoracic 8, end-plate fracture of thoracic 11, 12, lumbar 2-5 and compression fracture of lumbar 1. The oral therapy was switched to ibandronate (3 mg) intravenously every 3 months. An X-ray in December 2002 showed 3 new additional end-plate fractures at thoracic 4, 6 and 7. Ibandronate was discontinued in September 2004 and the patient received daily subcutaneous (s. c.) injections of 1-34 PTH in September 2005.
  
  
  RESULTS
  After starting 1-34 PTH treatment for 18 months, a further increase in bone mineral density (BMD) was achieved without any further fracture.
  
  
  CONCLUSIONS
  We presented for the first time a case of severe PAO with 11 spine fractures. We observed an unsatisfactory effect of oral and i. v. bisphosphonates in combination with adequate calcium and vitamin D supplementation. The treatment with 1-34 PTH showed an increase in BMD with no further fractures.
authors.affiliation: Department of Gynecological Endocrinology, Reproductive Medicine and Osteoporosis, Phillipps-University of Marburg, Marburg, Germany.
authors.forename: A S
authors.initials: AS
authors.lastname: Winarno
authors.affiliation: Department of Obstetrics and Gynecology, Philipps-University of Marburg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Kyvernitakis
authors.affiliation: Department of Endocrinology, Reproductive Medicine and Osteoporosis, Krankenhaus Nordwest, Frankfurt, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Hadji
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D006801:Humans; D009104:Multiple Trauma / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D010446:Peptide Fragments / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D019379:Teriparatide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D010446:Peptide Fragments; D019379:Teriparatide; C035748:parathyroid hormone (1-34)amide