Pregnancy- and Lactation-Associated Osteoporosis: A Literature Review Based on a Clinical Case

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare condition that affects women during pregnancy or postpartum. We report the case of a 29-year-old woman who experienced severe lower back pain 11 weeks after childbirth, revealing multiple compressive vertebral fractures in imaging studies. Despite no identifiable risk factors, the patient underwent an assessment ruling out secondary causes of osteoporosis, with only vitamin D deficiency and expected alterations in bone biomarkers identified. Treatment involved chemically suppressing lactation, along with calcium and vitamin D supplementation. After three months of follow-up, vitamin D levels and bone biomarkers normalized, but the pain persisted, and bone mineral density decreased. The literature review underscores the lack of understanding regarding PLO's etiology and pathophysiology. Possible causes include genetic factors, alterations in calcium metabolism, and abnormalities in calcium transfer adaptation from the mother to the fetus. Treatment lacks standardization, but calcium and vitamin D supplementation are common. Therapies such as bisphosphonates, teriparatide, calcitonin, denosumab, and strontium ranelate have been evaluated, considering their effectiveness and safety. Due to the initial lack of improvement, teriparatide was initiated in this case. In conclusion, PLO poses a diagnostic challenge due to its low incidence and lack of comprehension of underlying mechanisms. Early diagnosis, personalized treatment, and strict monitoring are crucial for improving the prognosis of these patients.