Pregnancy and lactation associated osteoporosis - a rare bone breaker

Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition affecting women during the late pregnancy and early postpartum period. PLO is manifested with multiple fragility fractures mainly involving the spine with the height loss.

We report a 31-year-old lady presenting with severe lower back pain during early post-partum period after her second pregnancy. She reported history of similar back pain after delivery of first baby 2 years back. Vertebral imaging revealed multiple compressive fractures (Th9, L1 and L2). There was evident height loss of 7 cm compared to her pre-pregnancy height. Bone mineral density (BMD) assessment with the DXA scan revealed severe osteoporosis. She denied the family history of osteoporosis. Biochemical assessment showed normal levels of calcium, phosphorus, vitamin D and alkaline phosphatase. Secondary causes of osteoporosis were excluded. She was explained about the diagnosis and advised on cessation of breast-feeding, proper contraception, and lifestyle modifications. Calcium carbonate and vitamin D supplements were started with adequate pain relief. On 6 months follow-up, she had significant improvement in back pain, and she didn't have new fractures on repeat imaging. Repeat DXA scan showed significant improvement in the lumbar spine BMD. She is awaiting reassessment in 1 year.

The possibility of PLO should be considered during the evaluation of osteoporosis in women during late pregnancy and lactation, but exclusion of secondary causes is important before making the diagnosis. Appropriate supportive measures should be initiated to improve the quality of life and prevent further fractures.