title: Pregnancy and Lactation-Associated Osteoporosis: Bone Histomorphometric Analysis and Response to Treatment with Zoledronic Acid.
abstract: Pregnancy and lactation-associated osteoporosis (PAO) is a rare condition with little known pathophysiology. Most cases are diagnosed in the third trimester of pregnancy or in the first weeks postpartum, particularly in first pregnancies. Vertebral fractures are most commonly observed and characterised by prolonged severe pain, functional limitations and a loss of height. Measurements of bone mineral density and biochemical markers of bone remodelling are the clinical methods most commonly used for the management of these patients. However, a bone biopsy with histomorphometric analysis has been considered to be the gold-standard. Few studies have evaluated the histomorphometry in patients with this clinical condition and none of them performed the procedure at the beginning of the clinical assessment. In this study, we report a case of PAO in a 31-year-old postpartum patient who had undergone a twin pregnancy. We describe the clinical, laboratory tests and imaging features. Bone histomorphometry showed a high resorption rate and excellent evolution after 1 year of treatment with intravenous zoledronic acid. Our data suggest that osteoclastogenesis plays a central role in the pathophysiological processes of this disease.
authors.affiliation: Health Sciences Centre, UEM, Avenida Dr. Luiz Teixeira Mendes, 1888, Zona 05, Maringá, PR, CEP 87015-000, Brazil. felipegrizzo@gmail.com.
authors.forename: Felipe Merchan Ferraz
authors.initials: FM
authors.lastname: Grizzo
authors.affiliation: Department of Medicine, UEM, Maringá, PR, Brazil.
authors.forename: Janaina
authors.initials: J
authors.lastname: da Silva Martins
authors.affiliation: Rheumatology, UNIFESP, São Paulo, SP, Brazil.
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Pinheiro
authors.affiliation: Nephrology, USP, São Paulo, SP, Brazil.
authors.forename: Vanda
authors.initials: V
authors.lastname: Jorgetti
authors.affiliation: Department of Medicine, UEM, Maringá, PR, Brazil.
authors.forename: Maria Dalva Barros
authors.initials: MD
authors.lastname: Carvalho
authors.affiliation: Nursing Department, UEM, Maringá, PR, Brazil.
authors.forename: Sandra Marisa
authors.initials: SM
authors.lastname: Pelloso
mesh_terms: D000328:Adult; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001942:Breast Feeding / Q000009:adverse effects*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D007774:Lactation; D010024:Osteoporosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000503:physiopathology; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid
keywords: Bisphosphonates; Bone biopsy; Bone histomorphometry; Lactation; Osteoporosis; Pregnancy