Successful treatment of gonadotropin releasing hormone induced severe pregnancy and lactation-associated osteoporosis with teriparatide

Abstract

Pregnancy and lactation-associated osteoporosis (PLO) is characterized by significant changes in calcium and bone homeostasis and the subsequent occurrence of fragility fractures particularly in the vertebral bodies during third trimester of pregnancy or postpartum period. In this study, we present a case of PLO developed after gonadotropin releasing hormone (GnRH) therapy that had successfully been treated with teriparatide. A 34-yearold primiparous woman developed mechanical low back pain (LBP) in the 8th months of pregnancy. LBP exacerbated during the pregnancy and reached its maximum after delivery. Spinal radiographs and magnetic resonance imaging detected fractures in the T11-L2. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry and showed osteoporosis. Her past medical history was positive for receiving of GnRH one month before pregnancy. After the patient was diagnosed with PLO, breastfeeding was stopped. Calcium, vitamin D3 and teriparatide 20 mu g/d were started. Ten days after the treatment, improvement in the patient's pain and mobility was observed. Ten months after the treatment, control BMD showed a significant increase in the lumbar and hip BMD. No new fractures developed during the treatment.