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PREGNANCY ASSOCIATED OSTEOPOROSIS: CASE REPORT

Yıl 2020, Cilt: 21 Sayı: 2, 206 - 210, 11.05.2020
https://doi.org/10.18229/kocatepetip.526709

Öz

Pregnancy associated osteoporosis (PAO) is a rare cause of premenopausal osteoporosis. This clinical entity is characterized with severe back pain and multiple vertebral compression fractures during last trimester of pregnancy or postpartum period. Compression fractures cause shortening in heigth and kyphosis. This case report describes a 29-year-old GIO patient with multiple vertebral fractures who had severe back pain starting during the last trimester of pregnancy and worsening one week after delivery. Radiological examination with computed tomography demonstrated multiple compression fractures in T12, L1, L2, L3 and L5 vertebras. Bone mineral density (BMD) measurement reported total Z score for L1-4 as -3.3 and Z score for femoral neck as -1.6. It was recommended that the patient would stop breastfeeding, take vitamin D and calcium supplementation, attend the physical therapy program and use corset during a short period of time. Although anti-resorptive treatment (alendronate 70 mg / w) was recommended, the patient refused to use it because she had an expectation for future pregnancies and the long-term effects of bisphosphonates on the fetus were unclear. As the back pain of the patient improved, her visual analogue scale value decreased from 9 to 2. PAO should be considered in the differential diagnosis of pregnant and postpartum patients with back pain. Early diagnosis is important for taking necessary precautions and administering medical treatment.

Kaynakça

  • 1. Blanch J, Pacifici R, Chines A. Pregnancy-associated osteoporosis: Report of two cases with long-term bone density follow-up. Rheumatology. 1994;33(3):269–72.
  • 2. Nordin BEC, Roper. A Post-pregnancy osteoporos is a syndrome ? Lancet. 1955;265(6861):431–4.
  • 3. O’Sullivan SM, Grey AB, Singh R, Reid IR. Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int. 2006;17(7):1008–12.
  • 4. Scozzari F, Aronica GL, Seidita A, Taormina G, Di Stefano L, D’alcamo A, et al. Osteoporosis in pregnancy: A case report and review of the literature. Acta Medica Mediterr. 2014;30(1):115–20.
  • 5. Richens Y, Smith K, Leddington wright S. Lower back pain during pregnancy: Advice and exercises for women. British Journal of Midwifery. 2010;18: 562-6.
  • 6. Dunne F, Walters B, Marshall T, et al. Pregnancy associated osteoporosis. Clinical Endocrinology. 1993;39(4): 487-90.
  • 7. Peris P, Guañabens N, Monegal A, et al. Pregnancy associated osteoporosis: The familial effect. Clin Exp Rheumatol. 2002;20(5):697–700.
  • 8. Kraemer B, Schneider S, Rothmund R, Fehm T, Wallwiener D, Solomayer EF. Influence of pregnancy on bone density: A risk factor for osteoporosis? Measurements of the calcaneus by ultrasonometry. Arch Gynecol Obstet. 2012;285(4):907–12.
  • 9. Thomas M, Weisman SM. Calcium supplementation during pregnancy and lactation: Effects on the mother and the fetus. Am J Obstet Gynecol. 2006;194(4):937–45.
  • 10. Kovacs CS. Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia. 2005;10(2):105–18.
  • 11. Pola E, Colangelo D, Nasto L.A, et al. Pregnancy-associated osteoporosis (pao)wiıth multiple vertebral fragılıty fractures: Diagnosis and treatment in a young primigravid woman. J Biol Regul Homeost Agents. 2016;30(3):151-6.
  • 12. Kovacs CS, Ralston SH. Presentation and management of osteoporosis presenting in association with pregnancy or lactation. Osteoporos Int. 2015;26(9):2223–41.
  • 13. Phillips AJ, Ostlere SJ, Smith R. Pregnancy-associated osteoporosis: Does the skeleton recover? Osteoporos Int. 2000;11(5):449–54.
  • 14. Akyüz G., Bayındır Ö. Gebelik İle İlişkili Osteoporoz. Turk J Phys Med Rehab. 2013;(59):145–50.
  • 15. Hellmeyer L, Boekhoff J, Hadji P. Treatment with teriparatide in a patient with pregnancy-associated osteoporosis. Gynecol Endocrinol. 2010;26(10):725–8.

GEBELİKLE İLİŞKİLİ OSTEOPOROZ: OLGU SUNUMU

Yıl 2020, Cilt: 21 Sayı: 2, 206 - 210, 11.05.2020
https://doi.org/10.18229/kocatepetip.526709

Öz

Gebelikle ilişkili osteoporoz (GİO), nadir görülen bir premenapozal osteoporoz tipidir. Gebeliğin son üç ayında veya postpartum dönemde görülen şiddetli bel ağrısı, vertebra kırıklarına ikincil boy kısalması ve kifoz semptomları ile karşımıza çıkmaktadır. Bu olgu sunumunda, gebeliğin son üç ayında başlayan ve doğumdan bir hafta sonra şiddetlenen sırt ağrısı ve çoklu vertebral kırığı olan 29 yaşındaki GİO hastası tanımlanmıştır. Son trimesterde başlayan ve doğumdan 1 hafta sonra giderek kötüleşen şiddetli bel ağrısı nedeniyle çekilen bilgisayarlı tomografide T12, L1, L2, L3 ve L5 vertebralarda kompresyon kırıkları saptandı. Kemik mineral yoğunluğu (KMY) ölçümünde; L1-4 için total Z skoru -3.3 ve femur boynu için Z skoru -1.6 olarak bulundu. Hastanın emzirmeyi sonlandırması, D vitamini ve kalsiyum desteği alması, fizik tedavi programına devam etmesi ve kısa süreli olarak korse kullanması önerildi. Anti-rezorptif ajan (alendronat 70 mg/hf) kullanması önerilen hasta, ilerleyen dönemde gebelik beklentisi olması ve bifosfonatların uzun dönem etkilerinin net olmaması nedeniyle bu tedaviye devam etmeyi reddetti. Ağrısı giderek azalan hastanın görsel analog skala değeri 9’dan 2’ye geriledi. Gebe ve loğusa hastalardaki bel ağrısının ayırıcı tanısında GİO göz önünde bulundurulmalıdır. Tanının erken dönemde konulması, önlem almayı ve gerekli tıbbi tedaviyi başlamayı kolaylaştıracaktır.

Kaynakça

  • 1. Blanch J, Pacifici R, Chines A. Pregnancy-associated osteoporosis: Report of two cases with long-term bone density follow-up. Rheumatology. 1994;33(3):269–72.
  • 2. Nordin BEC, Roper. A Post-pregnancy osteoporos is a syndrome ? Lancet. 1955;265(6861):431–4.
  • 3. O’Sullivan SM, Grey AB, Singh R, Reid IR. Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int. 2006;17(7):1008–12.
  • 4. Scozzari F, Aronica GL, Seidita A, Taormina G, Di Stefano L, D’alcamo A, et al. Osteoporosis in pregnancy: A case report and review of the literature. Acta Medica Mediterr. 2014;30(1):115–20.
  • 5. Richens Y, Smith K, Leddington wright S. Lower back pain during pregnancy: Advice and exercises for women. British Journal of Midwifery. 2010;18: 562-6.
  • 6. Dunne F, Walters B, Marshall T, et al. Pregnancy associated osteoporosis. Clinical Endocrinology. 1993;39(4): 487-90.
  • 7. Peris P, Guañabens N, Monegal A, et al. Pregnancy associated osteoporosis: The familial effect. Clin Exp Rheumatol. 2002;20(5):697–700.
  • 8. Kraemer B, Schneider S, Rothmund R, Fehm T, Wallwiener D, Solomayer EF. Influence of pregnancy on bone density: A risk factor for osteoporosis? Measurements of the calcaneus by ultrasonometry. Arch Gynecol Obstet. 2012;285(4):907–12.
  • 9. Thomas M, Weisman SM. Calcium supplementation during pregnancy and lactation: Effects on the mother and the fetus. Am J Obstet Gynecol. 2006;194(4):937–45.
  • 10. Kovacs CS. Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia. 2005;10(2):105–18.
  • 11. Pola E, Colangelo D, Nasto L.A, et al. Pregnancy-associated osteoporosis (pao)wiıth multiple vertebral fragılıty fractures: Diagnosis and treatment in a young primigravid woman. J Biol Regul Homeost Agents. 2016;30(3):151-6.
  • 12. Kovacs CS, Ralston SH. Presentation and management of osteoporosis presenting in association with pregnancy or lactation. Osteoporos Int. 2015;26(9):2223–41.
  • 13. Phillips AJ, Ostlere SJ, Smith R. Pregnancy-associated osteoporosis: Does the skeleton recover? Osteoporos Int. 2000;11(5):449–54.
  • 14. Akyüz G., Bayındır Ö. Gebelik İle İlişkili Osteoporoz. Turk J Phys Med Rehab. 2013;(59):145–50.
  • 15. Hellmeyer L, Boekhoff J, Hadji P. Treatment with teriparatide in a patient with pregnancy-associated osteoporosis. Gynecol Endocrinol. 2010;26(10):725–8.
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Olgu Sunumu
Yazarlar

Nuran Eyvaz 0000-0001-7810-9004

Yayımlanma Tarihi 11 Mayıs 2020
Kabul Tarihi 8 Nisan 2019
Yayımlandığı Sayı Yıl 2020 Cilt: 21 Sayı: 2

Kaynak Göster

APA Eyvaz, N. (2020). GEBELİKLE İLİŞKİLİ OSTEOPOROZ: OLGU SUNUMU. Kocatepe Tıp Dergisi, 21(2), 206-210. https://doi.org/10.18229/kocatepetip.526709
AMA Eyvaz N. GEBELİKLE İLİŞKİLİ OSTEOPOROZ: OLGU SUNUMU. KTD. Mayıs 2020;21(2):206-210. doi:10.18229/kocatepetip.526709
Chicago Eyvaz, Nuran. “GEBELİKLE İLİŞKİLİ OSTEOPOROZ: OLGU SUNUMU”. Kocatepe Tıp Dergisi 21, sy. 2 (Mayıs 2020): 206-10. https://doi.org/10.18229/kocatepetip.526709.
EndNote Eyvaz N (01 Mayıs 2020) GEBELİKLE İLİŞKİLİ OSTEOPOROZ: OLGU SUNUMU. Kocatepe Tıp Dergisi 21 2 206–210.
IEEE N. Eyvaz, “GEBELİKLE İLİŞKİLİ OSTEOPOROZ: OLGU SUNUMU”, KTD, c. 21, sy. 2, ss. 206–210, 2020, doi: 10.18229/kocatepetip.526709.
ISNAD Eyvaz, Nuran. “GEBELİKLE İLİŞKİLİ OSTEOPOROZ: OLGU SUNUMU”. Kocatepe Tıp Dergisi 21/2 (Mayıs 2020), 206-210. https://doi.org/10.18229/kocatepetip.526709.
JAMA Eyvaz N. GEBELİKLE İLİŞKİLİ OSTEOPOROZ: OLGU SUNUMU. KTD. 2020;21:206–210.
MLA Eyvaz, Nuran. “GEBELİKLE İLİŞKİLİ OSTEOPOROZ: OLGU SUNUMU”. Kocatepe Tıp Dergisi, c. 21, sy. 2, 2020, ss. 206-10, doi:10.18229/kocatepetip.526709.
Vancouver Eyvaz N. GEBELİKLE İLİŞKİLİ OSTEOPOROZ: OLGU SUNUMU. KTD. 2020;21(2):206-10.

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