Pregnancy-associated osteoporosis: a case-control study

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Abstract

The etiology and underlying mechanisms of pregnancy-associated osteoporosis (PAO) are still unknown, since no systematic analyses exist. Our results indicate that PAO is a heterogeneous, rare but severe disease including a substantial number of fractures with a significant delay from first symptom to diagnose.

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Osteoporosis in young adults: pathophysiology, diagnosis, and management.

S. Ferrari, M. L. Bianchi, J. Eisman … (2012)

Postmenopausal osteoporosis is mainly caused by increased bone remodeling resulting from estrogen deficiency. Indications for treatment are based on low areal bone mineral density (aBMD, T-score ≤ -2.5), typical fragility fractures (spine or hip), and more recently, an elevated 10-year fracture probability (by FRAX®). In contrast, there is no clear definition of osteoporosis nor intervention thresholds in younger individuals. Low aBMD in a young adult may reflect a physiologically low peak bone mass, such as in lean but otherwise healthy persons, whereas fractures commonly occur with high-impact trauma, i.e., without bone fragility. Furthermore, low aBMD associated with vitamin D deficiency may be highly prevalent in some regions of the world. Nevertheless, true osteoporosis in the young can occur, which we define as a T-score below -2.5 at spine or hip in association with a chronic disease known to affect bone metabolism. In the absence of secondary causes, the presence of fragility fractures, such as in vertebrae, may point towards genetic or idiopathic osteoporosis. In turn, treatment of the underlying condition may improve bone mass as well. In rare cases, a bone-specific treatment may be indicated, although evidence is scarce for a true benefit on fracture risk. The International Osteoporosis Foundation (IOF) convened a working group to review pathophysiology, diagnosis, and management of osteoporosis in the young, excluding children and adolescents, and provide a screening strategy including laboratory exams for a systematic approach of this condition.

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Pathophysiology of bone loss in disuse osteoporosis.

Christian Alexandre, Laurence Vico (2011)

Osteoporosis, or rather the localised bone loss observed in patients with spinal cord injury, as well as during any type of immobilisation involves various processes and structures including the direct response of the musculoskeletal system to unloading, the central and peripheral nervous systems and their effects on bone cells and on the vascular system, the bone remodelling unit in its marrow compartment and a number of local factors controlling cell-cell cross-talk as well as calciotropic hormones. The authors present a detailed review of these different mechanisms which are all involved regardless of the type of immobilisation: pathological, environmental, or experimental. These factors are interconnected and put bone at the centre of the regulation of body homeostasis. A better knowledge of these mechanisms should promote the development of preventive therapies for the often neglected osteoporotic fractures that occur in patients with spinal cord injury. Copyright © 2011 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

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Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin.

T Dahlman (1993)

To study the effect of long-term treatment during gestation with heparin on the incidence of osteoporotic fractures and thromboembolic recurrence. Long-term subcutaneous prophylaxis with heparin twice daily in pregnancy was prescribed for 184 women, during a decade because of an increased risk of thromboembolism. The dosage of heparin was adjusted to anti-factor Xa activity or activated partial thromboplastin time and different regimens were given, depending on the risk of recurrence. For the total group the mean dosage of heparin ranged from 13,000 to 40,000 IU per 24 hours (mean 19,100 IU per 24 hours), and the average duration of treatment was 25 weeks. Symptomatic osteoporotic fractures of the spine occurred post partum in four women, for whom the mean dosage of heparin ranged from 15,000 to 30,000 IU per 24 hours (mean 24,500 IU per 24 hours), and the duration of treatment ranged from 7 to 27 weeks (mean 17 weeks). In spite of prophylaxis with heparin, thromboembolic complications occurred in five women. They had either nonsatisfactory concentrations of heparin according to our regimen or were later diagnosed as having a coagulation disorder known to increase the risk of thromboembolism. Osteoporotic vertebral fractures were found in 2.2% of the women, and a relationship to the amount of heparin was indicated, although fractures were not avoided during low-dose, short-term prophylaxis. Recurrence of thromboembolism occurred in 2.7% of the patients, but if a strict heparin adjustment had been performed, recurrence could probably have been prevented.