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Clinical characteristics and bisphosphonates treatment of rare pregnancy- and lactation-associated osteoporosis

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Abstract

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare disorder with poorly known etiology, pathophysiology, and therapy. We aimed to investigate the clinical characteristics of PLO and evaluate the effectiveness and safety of bisphosphonates on it. A total of 12 patients were diagnosed with PLO on the basis of medical history, bone mineral density (BMD), and/or fragility fractures during pregnancy and lactation. We investigated the clinical, biochemical, and radiological characteristics of patients. We assessed the effects of alendronate or zoledronic acid through observing the changes of bone turnover biomarkers and BMD during the treatment. Secondary osteoporosis was excluded by comprehensive differential diagnosis. The mean age of these patients was 31 ± 5 years old. All of these patients presented severe back pain. Multiple vertebral compression fractures (VCFs) were found in 10 patients, and the median (P25th, P75th) number of compressed vertebra was 3 (3, 5). Ten patients had vitamin D insufficiency or deficiency. Serum level of bone resorption marker (β-CTX with mean of 0.68 ± 0.41 ng/ml) was moderately higher than the normal range. BMD at lumbar spine, femoral neck, and total hip were low as 0.894 ± 0.153 g/cm2, 0.728 ± 0.090 g/cm2, and 0.728 ± 0.080 g/cm2, respectively. Either alendronate or zoledronic acid could effectively relieve bone pain, reduce β-CTX level, and increase BMD. PLO is a rare type of osteoporosis, which was characterized by increased bone resorption and decreased BMD, even VCFs. Bisphosphonate therapy was well tolerated and effective in management of PLO, but needed to be further verified in randomized controlled trial.

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Acknowledgments

We appreciate all patients for their participation into this study.

Funding

This study is supported by grants from the National Natural Science Foundation of China (No. 81570802), Chinese Academy of Medical Sciences Innovative Fund for Medical Sciences (CIFMS) (2016-I2M-3-003), and the National Key Research and Development Program of China (No. 2016YFC0901501).

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Authors and Affiliations

  1. Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China

    Lu-jiao Li, Fang Lv, Yu-wen Song, Di-chen Zhao, Ou Wang, Yan Jiang, Xiao-ping Xing, Wei-bo Xia & Mei Li

  2. Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Jia Zhang & Peng Gao

  3. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Xiao-yan Chang

Authors
  1. Lu-jiao Li
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  2. Jia Zhang
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  3. Peng Gao
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  4. Fang Lv
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  5. Yu-wen Song
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  8. Ou Wang
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  9. Yan Jiang
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  10. Xiao-ping Xing
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  11. Wei-bo Xia
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  12. Mei Li
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Contributions

L.J.L. analyzed the data and wrote the manuscript. J.Z., P.G., F.L., Y.W.S., X.Y.C., and D.C.Z. contributed to data collection. O.W., Y.J., and X.P.X. contributed to review the manuscript. M.L. and W.B.X. contributed to the conception and design of the research, acquisition and interpretation of the data, and revised the manuscript.

Corresponding authors

Correspondence to Wei-bo Xia or Mei Li.

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This study was approved by the Scientific Ethics Committee of PUMCH.

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Li, Lj., Zhang, J., Gao, P. et al. Clinical characteristics and bisphosphonates treatment of rare pregnancy- and lactation-associated osteoporosis. Clin Rheumatol 37, 3141–3150 (2018). https://doi.org/10.1007/s10067-018-4185-0

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  • DOI: https://doi.org/10.1007/s10067-018-4185-0

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