Bilateral Femoral Head Insufficiency Fractures and Multiple Vertebral Fractures: A Case Report on Rare Presentations of Pregnancy and Lactation-associated Osteoporosis and Their Outcomes

Abstract

Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition seen in the last trimester of pregnancy and early puerperal period which can result in vertebral and femoral fractures. In this case report, two cases of fractures secondary to PLO, their management and clinical outcomes are presented. Case one describes a patient with vertebral fractures secondary to PLO who was treated with bisphosphonates. Case two describes a rare case of bilateral femoral head stress fractures secondary to PLO, treated with bed rest, a home exercise programme and calcium and vitamin D supplementations. Pharmacological treatment of PLO includes teriparatide and strontium ranelate and crossover treatments-all of which require the cessation of breastfeeding. The optimal PLO treatment remains to be determined. Further studies comparing the clinical and biological outcomes of these drugs are necessary so that clinicians can accurately advise women on the risks and benefits of each, for both themselves and their child and guide patients in making a suitably informed decision regarding treatment.

Keywords

• osteoporosis
• osteoporotic fractures
• lactation
• thoracic vertebrae
• femur head