Skip to main content
Erschienen in: Rheumatology International 3/2012

01.03.2012 | Short Communication

Pregnancy-associated spinal osteoporosis treated with bisphosphonates: long-term follow-up of maternal and infants outcome

verfasst von: Nada Vujasinovic-Stupar, Nada Pejnovic, Ljiljana Markovic, Maja Zlatanovic

Erschienen in: Rheumatology International | Ausgabe 3/2012

Einloggen, um Zugang zu erhalten

Abstract

Pregnancy-associated spinal osteoporosis (PPSO) is a rare condition characterized by severe back pain occurring near the end of the first pregnancy or shortly afterward. The aim of this report is to present a 12-year follow-up of a patient with PPSO. Also, the outcomes of patient’s two pregnancies and her infants after long-term treatment with bisphosphonates are assessed. A young woman was referred to our tertiary care hospital aged 30 years, due to intense pain in thoracic and lumbar region that started during the last month of her first pregnancy and got worse after delivery. Bone mineral density (BMD) measurement, clinical, and biochemical parameters were performed. Extremely low lumbar spine BMD, L2–L4: 0.627 g/cm2, T-score −4.8, Z-score −4.3, 52% young adult indicated severe osteoporosis. Cyclical treatment with etidronate and then pamidronate was started, and a substantial increase in the BMD and the reduction in back pain intensity were observed. An increase in BMD of 44.8% over baseline was observed after 12 years of follow-up. Her two pregnancies were uneventful, and no neonatal adverse effects were observed. Control DXA scan in her girl child aged 6.8 years revealed low BMD at the lumbar spine. As PPSO seems to be an underdiagnosed severe disease, caution is recommended if back pain occurs in the last trimester or early post-partum period. Although pre-pregnancy use of bisphosponates does not pose a substantial fetal risk, their use in women of childbearing age might best be done only when strong clinical indications exist.
Literatur
1.
Zurück zum Zitat Bianchi ML (2009) Osteoporosis during pregnancy. Eur Musculoskel Rev 4(2):30–34 Bianchi ML (2009) Osteoporosis during pregnancy. Eur Musculoskel Rev 4(2):30–34
2.
Zurück zum Zitat Ofluoglu O, Ofluoglu D (2008) A case report: pregnancy-induced severe osteoporosis with eight vertebral fractures. Rheumatol Int 29(2):197–201PubMedCrossRef Ofluoglu O, Ofluoglu D (2008) A case report: pregnancy-induced severe osteoporosis with eight vertebral fractures. Rheumatol Int 29(2):197–201PubMedCrossRef
3.
Zurück zum Zitat Sarikaya S, Ozdolap S, Açikgöz G, Erdem CZ (2004) Pregnancy-associated osteoporosis with vertebral fractures and scoliosis. Joint Bone Spine 71(1):84–85PubMedCrossRef Sarikaya S, Ozdolap S, Açikgöz G, Erdem CZ (2004) Pregnancy-associated osteoporosis with vertebral fractures and scoliosis. Joint Bone Spine 71(1):84–85PubMedCrossRef
4.
Zurück zum Zitat Gedes AD, D’Souza SM, Ebetino FH, Ibbotson KJ (1994) Bisphosphonates: structure-activity relationships and therapeutic implications. J Bone Miner Res 8:265–306 Gedes AD, D’Souza SM, Ebetino FH, Ibbotson KJ (1994) Bisphosphonates: structure-activity relationships and therapeutic implications. J Bone Miner Res 8:265–306
5.
Zurück zum Zitat Cremers SC, Papapoulos SE, Gerderblom H, Seynaeve C, den Hartigh J, Vermeij P et al (2005) Skeletal retention of bisphosphonate (pamidronate) and its relation to the rate of bone resorption in patients with breast cancer and bone metastases. J Bone Miner Res 20(9):1543–1547PubMedCrossRef Cremers SC, Papapoulos SE, Gerderblom H, Seynaeve C, den Hartigh J, Vermeij P et al (2005) Skeletal retention of bisphosphonate (pamidronate) and its relation to the rate of bone resorption in patients with breast cancer and bone metastases. J Bone Miner Res 20(9):1543–1547PubMedCrossRef
6.
Zurück zum Zitat Djokanovic N, Klieger-Grossmann C, Koren G (2008) Does treatment with bisphosponates endanger the human pregnancy? J Obstet Gynaecol Can 30(12):1146–1148PubMed Djokanovic N, Klieger-Grossmann C, Koren G (2008) Does treatment with bisphosponates endanger the human pregnancy? J Obstet Gynaecol Can 30(12):1146–1148PubMed
7.
Zurück zum Zitat Kovacs CS (2005) Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia 10(2):105–118PubMedCrossRef Kovacs CS (2005) Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia 10(2):105–118PubMedCrossRef
8.
Zurück zum Zitat Karlsson MK, Ahiborg HG, Karlsson C (2005) Maternity and bone mineral density. Acta Orthop 76(1):2–13PubMedCrossRef Karlsson MK, Ahiborg HG, Karlsson C (2005) Maternity and bone mineral density. Acta Orthop 76(1):2–13PubMedCrossRef
9.
Zurück zum Zitat Black AJ, Topping J, Durham B, Farquharson RG, Fraser WD (2000) A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J Bone Miner Res 15(3):557–563PubMedCrossRef Black AJ, Topping J, Durham B, Farquharson RG, Fraser WD (2000) A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J Bone Miner Res 15(3):557–563PubMedCrossRef
10.
Zurück zum Zitat Naylor KE, Iqbal P, Fledelius C, Fraser RB, Eastell R (2000) The effect of pregnancy on bone density and bone turnover. J Bone Miner Res 15(1):129–137PubMedCrossRef Naylor KE, Iqbal P, Fledelius C, Fraser RB, Eastell R (2000) The effect of pregnancy on bone density and bone turnover. J Bone Miner Res 15(1):129–137PubMedCrossRef
11.
Zurück zum Zitat Phillips AJ, Ostlere SJ, Smith R (2000) Pregnancy-associated osteoporosis: does the skeleton recover? Osteoporos Int 11:449–454PubMedCrossRef Phillips AJ, Ostlere SJ, Smith R (2000) Pregnancy-associated osteoporosis: does the skeleton recover? Osteoporos Int 11:449–454PubMedCrossRef
12.
Zurück zum Zitat O’Sullivan SM, Grey AB, Singh R, Reid IR (2006) Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int 17(7):1008–1012PubMedCrossRef O’Sullivan SM, Grey AB, Singh R, Reid IR (2006) Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int 17(7):1008–1012PubMedCrossRef
13.
Zurück zum Zitat Tanriover MD, Oz SG, Sozen T, Kilicarslan A, Guven GS (2009) Pregnancy-and lactation-associated osteoporosis with severe vertebral deformities: can strontium ranelate be a new alternative for the treatment ? Spin J 9(4):e20–e24CrossRef Tanriover MD, Oz SG, Sozen T, Kilicarslan A, Guven GS (2009) Pregnancy-and lactation-associated osteoporosis with severe vertebral deformities: can strontium ranelate be a new alternative for the treatment ? Spin J 9(4):e20–e24CrossRef
14.
Zurück zum Zitat Stumpf UC, Kurth AA, Windolf J, Fassbender WJ (2007) Pregnancy-associated osteoporosis: an underestimated and underdiagnosed severe disease. A review of two cases in short- and long-term follow-up. Adv Med Sci 52:94–97PubMed Stumpf UC, Kurth AA, Windolf J, Fassbender WJ (2007) Pregnancy-associated osteoporosis: an underestimated and underdiagnosed severe disease. A review of two cases in short- and long-term follow-up. Adv Med Sci 52:94–97PubMed
15.
Zurück zum Zitat Bayram S, Ozturk C, Sivrioglu K, Aydinli U, Kucukoglu S (2006) Kyphoplasty for pregnancy-associated osteoporotic vertebral fractures. Joint Bone Spine 73(5):564–566PubMedCrossRef Bayram S, Ozturk C, Sivrioglu K, Aydinli U, Kucukoglu S (2006) Kyphoplasty for pregnancy-associated osteoporotic vertebral fractures. Joint Bone Spine 73(5):564–566PubMedCrossRef
16.
Zurück zum Zitat Patlas N, Golomb G, Yaffe P, Pinto T, Breuer E, Ornoy A (1999) Transplacental effects of bisphophonates on fetal skeletal ossification and mineralization in rats. Teratology 60(2):68–73PubMedCrossRef Patlas N, Golomb G, Yaffe P, Pinto T, Breuer E, Ornoy A (1999) Transplacental effects of bisphophonates on fetal skeletal ossification and mineralization in rats. Teratology 60(2):68–73PubMedCrossRef
17.
Zurück zum Zitat Levy S, Fayez I, Taguchi N, Han JY, Aiello J, Matsui D et al (2009) Pregnancy outcome following in utero exposure to bisphosponates. Bone 44(3):428–430PubMedCrossRef Levy S, Fayez I, Taguchi N, Han JY, Aiello J, Matsui D et al (2009) Pregnancy outcome following in utero exposure to bisphosponates. Bone 44(3):428–430PubMedCrossRef
18.
Zurück zum Zitat Hassen-Zrour S, Korbâa W, Béjia I, Saidani Z, Bergaoui N (2010) Maternal and fetal outcome after long-term bisphosphonate exposure before conception. Osteoporos Int 21(4):709–710PubMedCrossRef Hassen-Zrour S, Korbâa W, Béjia I, Saidani Z, Bergaoui N (2010) Maternal and fetal outcome after long-term bisphosphonate exposure before conception. Osteoporos Int 21(4):709–710PubMedCrossRef
19.
Zurück zum Zitat Ornoy A, Wajnberg R, Diav-Citrin O (2006) The outcome of pregnancy following pre-pregnancy of early pregnancy alendronate treatment. Reprod Toxicol 22(4):578–579PubMedCrossRef Ornoy A, Wajnberg R, Diav-Citrin O (2006) The outcome of pregnancy following pre-pregnancy of early pregnancy alendronate treatment. Reprod Toxicol 22(4):578–579PubMedCrossRef
20.
Metadaten
Titel
Pregnancy-associated spinal osteoporosis treated with bisphosphonates: long-term follow-up of maternal and infants outcome
verfasst von
Nada Vujasinovic-Stupar
Nada Pejnovic
Ljiljana Markovic
Maja Zlatanovic
Publikationsdatum
01.03.2012
Verlag
Springer-Verlag
Erschienen in
Rheumatology International / Ausgabe 3/2012
Print ISSN: 0172-8172
Elektronische ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-011-1816-z

Weitere Artikel der Ausgabe 3/2012

Rheumatology International 3/2012 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.