PO:20:014 | Post-partum osteoporosis: severe clinical presentation in absence of known risk factors

Domenico Birra¹, Ludovica Frances Grasso², Vittoria Gammaldi¹, Antonietta De Sena¹, Carmine Pio Petrosino², Rosalia Boccia², Gabriella Oliva¹, Vincenzo Nuzzo¹ | ¹Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma; ²Istituto Superiore di Sanità, Roma

Background. Post-partum osteoporosis is a rare and under-recognized secondary osteoporosis that can manifest with multiple vertebral fractures in young women during the peripartum period. Early diagnosis and timely therapy improves outcomes.

Materials and Methods. A 34-year-old woman in satisfactory health, without known osteoporosis risk factors, developed worsening low back pain two months after delivery during exclusive breastfeeding. Symptoms worsened, leading to bedridden status and functional impairment. A spine X-ray revealed L1 vertebral fracture; one month later, L4 fracture was detected. MRI confirmed recent L1, L2 and L4 fractures. DEXA scan showed severe osteoporosis with a lumbar T-score of -3.5 and a femoral of -2. Treatment with teriparatide 20 µg/day and cholecalciferol supplementation was started. Clinical and laboratory follow-up at 6 and 12 months were performed.

Results. After 6 months, the patient reported clinical improvement with complete pain control, no new fractures, and resumption of physical activity. Laboratory tests were normal. Vitamin D was 27.6 ng/mL, PTH 64.4 pg/mL. At 12 months, bone density improved, and no further fractures occurred.

Conclusions. This case underlines the importance of suspecting postpartum osteoporosis in persistent peripartum low back pain and demonstrates that early anabolic therapy with teriparatide can lead to rapid clinical and functional recovery, preventing further fractures.