title: Four-year follow-up of pregnancy-associated osteoporosis: a case report.
abstract: A 22-year-old woman presented with complaints of severe pain in a wide region of the thoracolumbar spine. She developed severe pain in the thoracolumbar spine region 2 months after her first delivery and was referred 1 month later. A lateral thoracic X-ray showed depressed degenerative vertebrae (T7, T9). One month after the initial examination, thoracic sagittal magnetic resonance imaging showed low intensity areas on T1-weighted imaging and iso-high intensity areas on T2-weighted imaging at T5, 7, 8, 9 and 11. Bone mineral density measured by ultrasound was low (%YAM 76%). The bone metabolic markers were high, suggesting accelerated osteoclast activity. These findings prompted a diagnosis of pregnancy-associated osteoporosis. She was asked to stop breastfeeding and to wear a lumbar brace, and treatment with nutritional calcium, activated vitamin D3, and risedronate sodium was started. Her low back pain almost disappeared after treatment. Bone metabolic markers showed normalization 8 months after the initial examination. Risedronate sodium was stopped 2 years and 2 months after the initial examination. Teriparatide treatment was started because her bone mineral density remained low; however, the osteoblast marker P1NP was not increased 5 months after the start of teriparatide treatment.
authors.affiliation: Department of Orthopaedic Surgery, Southern Tohoku General Hospital, Fukushima, Japan; Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Takahashi
authors.forename: Itaru
authors.initials: I
authors.lastname: Arai
authors.forename: Satoru
authors.initials: S
authors.lastname: Kayama
authors.forename: Kenji
authors.initials: K
authors.lastname: Ichiji
authors.forename: Hironari
authors.initials: H
authors.lastname: Fukuda
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Handa
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Konno
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D010024:Osteoporosis / Q000188:drug therapy / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000209:etiology*; D000068296:Risedronic Acid / Q000627:therapeutic use; D019379:Teriparatide / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide; D000068296:Risedronic Acid