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Influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis

Pregnancy and lactation-associated osteoporosis (PLO) with predominantly subsequent vertebral fracture is a rare but severe disease with an estimated incidence of 0.4 in 100,000. In the past, patients with PLO have been predominantly treated with oral and i.v. bisphosphonates to reduce subsequent fr...

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Autores principales: Stumpf, U., Kraus, M., Hadji, P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer London 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8563672/
https://www.ncbi.nlm.nih.gov/pubmed/34041561
http://dx.doi.org/10.1007/s00198-021-06008-z
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author Stumpf, U.
Kraus, M.
Hadji, P.
author_facet Stumpf, U.
Kraus, M.
Hadji, P.
author_sort Stumpf, U.
collection PubMed
description Pregnancy and lactation-associated osteoporosis (PLO) with predominantly subsequent vertebral fracture is a rare but severe disease with an estimated incidence of 0.4 in 100,000. In the past, patients with PLO have been predominantly treated with oral and i.v. bisphosphonates to reduce subsequent fracture risk. Hereby, the use of bisphosphonates in premenopausal women is controversial, as bisphosphonates know to persist in bone for many years and can be exposed and circulate in maternal serum and subsequently pass the placenta barrier and may have a detrimental effect on fetal bone health. Here we report the effects of denosumab on the bone mineral density (BMD) and subsequent fracture risk in PLO. In this case presentation, denosumab was administered postpartum with 3000 IE vitamin D and 1000 mg of calcium daily in a patient with PLO and vertebral fracture of L1 and L4. After 18 months of treatment with denosumab, we could demonstrate a clinical significant increase of BMD at the lumbar spine, femoral neck, and total hip of 32.2%, 13.0%, and 11.5% respectively with no further subsequent fractures. As the patient had regular menstrual cycles and considered a further pregnancy, denosumab treatment was terminated and soon a second pregnancy occurred. After the second pregnancy, BMD decreased at the lumbar spine, femur neck, and total hip by −8.8%, −6.9%, and −7.0% respectively compared to the maximum values during treatment with denosumab, but was still significantly higher compared to baseline levels with no further fractures.
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spelling pubmed-85636722021-11-04 Influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis Stumpf, U. Kraus, M. Hadji, P. Osteoporos Int Case Report Pregnancy and lactation-associated osteoporosis (PLO) with predominantly subsequent vertebral fracture is a rare but severe disease with an estimated incidence of 0.4 in 100,000. In the past, patients with PLO have been predominantly treated with oral and i.v. bisphosphonates to reduce subsequent fracture risk. Hereby, the use of bisphosphonates in premenopausal women is controversial, as bisphosphonates know to persist in bone for many years and can be exposed and circulate in maternal serum and subsequently pass the placenta barrier and may have a detrimental effect on fetal bone health. Here we report the effects of denosumab on the bone mineral density (BMD) and subsequent fracture risk in PLO. In this case presentation, denosumab was administered postpartum with 3000 IE vitamin D and 1000 mg of calcium daily in a patient with PLO and vertebral fracture of L1 and L4. After 18 months of treatment with denosumab, we could demonstrate a clinical significant increase of BMD at the lumbar spine, femoral neck, and total hip of 32.2%, 13.0%, and 11.5% respectively with no further subsequent fractures. As the patient had regular menstrual cycles and considered a further pregnancy, denosumab treatment was terminated and soon a second pregnancy occurred. After the second pregnancy, BMD decreased at the lumbar spine, femur neck, and total hip by −8.8%, −6.9%, and −7.0% respectively compared to the maximum values during treatment with denosumab, but was still significantly higher compared to baseline levels with no further fractures. Springer London 2021-05-26 2021 /pmc/articles/PMC8563672/ /pubmed/34041561 http://dx.doi.org/10.1007/s00198-021-06008-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Case Report
Stumpf, U.
Kraus, M.
Hadji, P.
Influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis
title Influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis
title_full Influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis
title_fullStr Influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis
title_full_unstemmed Influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis
title_short Influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis
title_sort influence of denosumab on bone mineral density in a severe case of pregnancy-associated osteoporosis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8563672/
https://www.ncbi.nlm.nih.gov/pubmed/34041561
http://dx.doi.org/10.1007/s00198-021-06008-z
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