Treatment with teriparatide in a patient with pregnancy-associated osteoporosis

The decrease of BMD during a physiological pregnancy can in rare cases be intensified and lead to dramatic microarchitectural changes, which causes an increase incidence of fractures, preferably at the spine. This dramatic clinical picture is called pregnancy-associated osteoporosis.

We present the case of a 40-year-old woman (gravida IV, para II) with acute back pain right after delivery due to four fractures of the spine. The diagnosis was confirmed by dual-energy X-ray absorptiometry measurement result (T-score -4.1 SD (0.598 g/cm(2)) at the lumbar spine (L1-L4), T-score -1.5 SD (0.759 g/cm(2)) at the total hip). Due to the severity of symptoms, a therapy with teriparatide (20 mg daily) was started for a period of 18 months.

After end of therapy, the T-score had significantly increased at the lumbar spine as well as at the hip (T-score of -2.1 (0.813 g/cm(2)) and -0.6 (0.864 g/cm(2)), respectively. The relative increase of BMD at the spine and total hip was 36% and 13.8%, respectively.

Our report demonstrates the successful use of teriparatide underlined by the increase of bone mineral density and the improvement of clinical symptoms in a case of severe pregnancy-associated osteoporosis for the first time.