EP353 - ECE_3703 - Pregnancy- and lactation-associated osteoporosis presenting with multiple vertebral fractures and marked bone density recovery: a case report
Abstract
Pregnancy- and lactation-associated osteoporosis (PLO) is a rare cause of fragility fractures in young women, most often presenting with thoracolumbar vertebral fractures in late pregnancy or early postpartum. Early recognition is critical to prevent prolonged disability and to guide future pregnancy planning.
A 28-year-old woman (G1P1) developed severe back pain with ~5 cm height loss during the third trimester. Delivery occurred at 37 weeks’ gestation (06/2021). Postpartum spinal MRI demonstrated multiple vertebral compression fractures (Th11, Th12, L1, L2, L4). Past history included non-toxic nodular goiter (FNA Bethesda II) and vitamin D deficiency. BMI was 26.6 kg/m2. Secondary causes of osteoporosis (including celiac disease, Cushing syndrome, hyperparathyroidism, and hyperthyroidism) were excluded, supporting the diagnosis of PLO.
Baseline DXA (2021) showed severe osteoporosis: lumbar spine BMD 0.487 g/cm2 with Z-score −5.1 (L4 Z-score −5.6). Hip measurements were also low (e.g., left femoral neck BMD 0.516 g/cm2, T/Z −3.0; right femoral neck BMD 0.627 g/cm2, T/Z −2.0).
Serial DXA demonstrated substantial improvement:
01/2023: Lumbar spine BMD 0.768 g/cm2 (T-score −3.4), with reported gains vs baseline (lumbar + 57.7%; left femoral neck +46.5%; right femoral neck +30%).
09/2023: Lumbar spine BMD 0.784 g/cm2 (T-score −3.3; Z-score −3.4).
03/2024: Lumbar spine BMD 0.786 g/cm2 (T-score −3.3).
02/2025: Lumbar spine BMD 0.840 g/cm2 (T-score −2.2; Z-score −2.2), with…
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