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Post Pregnancy Severe Spinal Osteoporosis with Multiple Vertebral Fractures and Kyphoscoliosis in a Multigravida: A Rare Case with Management.

Hadgaonkar S, Shah KC, Bhatt H, Shyam A, Sancheti P - Asian Spine J (2015)

Bottom Line: Our patient presented at 4 month lactation and did not want to wean her infant, so she was treated with total contact orthosis and took vitamin D and calcium.The pain was relieved within 3 months but there was no improvement in bone density.After eight months when the infant was weaned, she was treated with teriparatide.

View Article: PubMed Central - PubMed

Affiliation: Sancheti Institute for Orthopaedics and Rehabilitation, Sancheti Hospital, Pune, India.

ABSTRACT
Osteoporosis associated with pregnancy and lactation is a less commonly known condition and often overlooked. The prevalence, exact aetiology and its pathogenesis are unknown. It is commonly seen in first three months after delivery in primigravida. It is often undiagnosed because of it not suspected n and X-rays and densitometry are avoided if possible during pregnancy and lactation. If missed, it can lead to osteoporotic fractures and disability. In this paper, we report a case of a 24-year-old multigravida 4 months after pregnancy with multiple vertebral compression fractures and kyphoscoliosis. Her metabolic workup was normal but bone densitometry revealed severe osteoporosis of the dorso-lumbar spine. Immediate weaning and antiresorptives like bisphosphonates and teriparatide are used as first line drugs to manage postpartum spinal osteoporosis. Our patient presented at 4 month lactation and did not want to wean her infant, so she was treated with total contact orthosis and took vitamin D and calcium. The pain was relieved within 3 months but there was no improvement in bone density. After eight months when the infant was weaned, she was treated with teriparatide. After one year of teriparatide therapy, there were no new fractures and densitometry scores improved.

No MeSH data available.


Related in: MedlinePlus

Thoracolumbar spine radiograph in anteroposterior and lateral view at eight months postpartum.
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Figure 4: Thoracolumbar spine radiograph in anteroposterior and lateral view at eight months postpartum.

Mentions: She was diagnosed with severe osteoporosis with multiple vertebral fractures and medical management and weaning was advised. She was reluctant to immediately wean her infant, so she was treated with total contact orthosis and vitamin D and calcium. At eight months postpartum, the pain subsided but DEXA scan showed no improvement in density scores. There were no new fractures detected on radiograph (Fig. 4). Lactation was stopped and she was started on teriparatide therapy along with vitamin D and calcium supplementation. At her one year follow-up, the patient was symptom free and DEXA scan showed improvement with T scores in the lumbar and hip region of -1.0 and -0.5, respectively.


Post Pregnancy Severe Spinal Osteoporosis with Multiple Vertebral Fractures and Kyphoscoliosis in a Multigravida: A Rare Case with Management.

Hadgaonkar S, Shah KC, Bhatt H, Shyam A, Sancheti P - Asian Spine J (2015)

Thoracolumbar spine radiograph in anteroposterior and lateral view at eight months postpartum.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522457&req=5

Figure 4: Thoracolumbar spine radiograph in anteroposterior and lateral view at eight months postpartum.
Mentions: She was diagnosed with severe osteoporosis with multiple vertebral fractures and medical management and weaning was advised. She was reluctant to immediately wean her infant, so she was treated with total contact orthosis and vitamin D and calcium. At eight months postpartum, the pain subsided but DEXA scan showed no improvement in density scores. There were no new fractures detected on radiograph (Fig. 4). Lactation was stopped and she was started on teriparatide therapy along with vitamin D and calcium supplementation. At her one year follow-up, the patient was symptom free and DEXA scan showed improvement with T scores in the lumbar and hip region of -1.0 and -0.5, respectively.

Bottom Line: Our patient presented at 4 month lactation and did not want to wean her infant, so she was treated with total contact orthosis and took vitamin D and calcium.The pain was relieved within 3 months but there was no improvement in bone density.After eight months when the infant was weaned, she was treated with teriparatide.

View Article: PubMed Central - PubMed

Affiliation: Sancheti Institute for Orthopaedics and Rehabilitation, Sancheti Hospital, Pune, India.

ABSTRACT
Osteoporosis associated with pregnancy and lactation is a less commonly known condition and often overlooked. The prevalence, exact aetiology and its pathogenesis are unknown. It is commonly seen in first three months after delivery in primigravida. It is often undiagnosed because of it not suspected n and X-rays and densitometry are avoided if possible during pregnancy and lactation. If missed, it can lead to osteoporotic fractures and disability. In this paper, we report a case of a 24-year-old multigravida 4 months after pregnancy with multiple vertebral compression fractures and kyphoscoliosis. Her metabolic workup was normal but bone densitometry revealed severe osteoporosis of the dorso-lumbar spine. Immediate weaning and antiresorptives like bisphosphonates and teriparatide are used as first line drugs to manage postpartum spinal osteoporosis. Our patient presented at 4 month lactation and did not want to wean her infant, so she was treated with total contact orthosis and took vitamin D and calcium. The pain was relieved within 3 months but there was no improvement in bone density. After eight months when the infant was weaned, she was treated with teriparatide. After one year of teriparatide therapy, there were no new fractures and densitometry scores improved.

No MeSH data available.


Related in: MedlinePlus