Challenges in the Management of Pregnancy and Lactation-Associated Osteoporosis (PLO) in Women of Childbearing age With Multiple Vertebral Fractures

Challenges in the Management of Pregnancy and Lactation-Associated Osteoporosis (PLO) in Women of Childbearing age With Multiple Vertebral Fractures

Loading document ...
Loading page ...


Author(s): Yang Liu, Genlong Jiao, Zhizhong Li

Download Full PDF Read Complete Article

DOI: 10.18483/ijSci.2233 35 266 15-18 Volume 8 - Dec 2019


Pregnancy and lactation-associated osteoporosis (PLO) is a rare but serious and difficult to be diagnosed disease, which occurs in the late gestation and early lactation, mainly manifested by low back pain, vertebral fracture and reduction of hip bone density. It is difficult to diagnose and has a high rate of misdiagnosis and mistreatment. We present the case of a 39-year-old woman who suffered from acute low back pain and walking difficulty after a sudden stoop in 2 months postnatal. The X-ray and MRI examination showed that fractures occurred in the first, second and fifth lumbar vertebrae. Bone mineral density (BMD) examination confirmed osteoporosis. After stopping lactation, calcium and vitamin K2 supplemented, compared with zoledronic acid injection, the low back pain was relieved and the BMD increased gradually. The incidence of PLO is seriously underestimated in clinical practice. Women in pregnancy and lactation with acute low back pain should be highly alert to the occurrence of PLO, and early treatment need to be taken in case of further serious consequences such as vertebral compression fracture or hip fracture.


Pregnancy and Lactation-Associated Osteoporosis (PLO), Osteoporosis, Vertebral Fracture, Bone Mineral Density


  1. Nordin BE, Roper A. Post-pregnancy osteoporosis; a syndrome? Lancet. 1955;268(6861):431-434.
  2. Smith R, Athanasou NA, Ostlere SJ, Vipond SE. Pregnancy-associated osteoporosis. QJM. 1995;88(12):865-878.
  3. O'Sullivan SM, Grey AB, Singh R, Reid IR. Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int. 2006;17(7):1008-1012.
  4. Vujasinovic-Stupar N, Pejnovic N, Markovic L, Zlatanovic M. Pregnancy-associated spinal osteoporosis treated with bisphosphonates: long-term follow-up of maternal and infants outcome. Rheumatol Int. 2012;32(3):819-823.
  5. Dunne F, Walters B, Marshall T, Heath DA. Pregnancy associated osteoporosis. Clin Endocrinol (Oxf). 1993;39(4):487-490.
  6. Butscheidt S, Delsmann A, Rolvien T, Barvencik F, Al-Bughaili M, Mundlos S, Schinke T, et al. Mutational analysis uncovers monogenic bone disorders in women with pregnancy-associated osteoporosis: three novel mutations in LRP5, COL1A1, and COL1A2. Osteoporos Int. 2018;29(7):1643-1651.
  7. Cohen A, Kamanda-Kosseh M, Dempster DW, Zhou H, Muller R, Goff E, Colon I, et al. Women With Pregnancy and Lactation-Associated Osteoporosis (PLO) Have Low Bone Remodeling Rates at the Tissue Level. J Bone Miner Res. 2019;34(9):1552-1561.
  8. Cooke-Hubley S, Gao Z, Mugford G, Kaiser SM, Goltzman D, Leslie WD, Davison KS, et al. Parity and lactation are not associated with incident fragility fractures or radiographic vertebral fractures over 16 years of follow-up: Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos. 2019;14(1):49.
  9. Chen J, Wang Q, Qiu L. 18F-FDG PET/CT in a Patient With Pregnancy and Lactation-Associated Osteoporosis. Clin Nucl Med. 2018;43(10):742-743.
  10. Kurabayashi T, Morikawa K. [Epidemiology and pathophysiology of post-pregnancy osteoporosis.]. Clin Calcium. 2019;29(1):39-45.
  11. Kurabayashi T. [Calcium and bone metabolism across women's life stages. Pathophysiology, adiagnosis and treatment of post-pregnancy osteoporosis.]. Clin Calcium. 2017;27(5):643-652.
  12. Ijuin A, Yoshikata H, Asano R, Tsuburai T, Kikuchi R, Sakakibara H. Teriparatide and denosumab treatment for pregnancy and lactation-associated osteoporosis with multiple vertebral fractures: A case study. Taiwanese Journal of Obstetrics and Gynecology. 2017;56(6):863-866.
  13. Kyvernitakis I, Reuter TC, Hellmeyer L, Hars O, Hadji P. Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up. Osteoporosis Int. 2018;29(1):135-142.
  14. Li LJ, Zhang J, Gao P, Lv F, Song YW, Chang XY, Zhao DC, et al. Clinical characteristics and bisphosphonates treatment of rare pregnancy- and lactation-associated osteoporosis. Clin Rheumatol. 2018;37(11):3141-3150.
  15. Sanz-Salvador L, Garcia-Perez MA, Tarin JJ, Cano A. Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture. Eur J Endocrinol. 2015;172(2):R53-R65.

Cite this Article:

International Journal of Sciences is Open Access Journal.
This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License.
Author(s) retain the copyrights of this article, though, publication rights are with Alkhaer Publications.

Search Articles

Issue June 2024

Volume 13, June 2024

Table of Contents

World-wide Delivery is FREE

Share this Issue with Friends:

Submit your Paper