Bone Microarchitecture and Strength Changes During Teriparatide and Zoledronic Acid Treatment in a Patient with Pregnancy and Lactation-Associated Osteoporosis with Multiple Vertebral Fractures

S. Treurniet, M.S.A.M. Bevers, C.E. Wyers, D. Micha, B.P. Teunissen, M.W. Elting, J.P. van den Bergh, E.M.W. Eekhoff*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Pregnancy- and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis, of which the pathogenesis and best treatment options are unclear. In this report, we describe the case of a 34-year old woman diagnosed with severe osteoporosis and multiple vertebral fractures after her first pregnancy, who was subsequently treated with teriparatide (TPTD) and zoledronic acid (ZA). We describe the clinical features, imaging examination, and genetic analysis. Substantial improvements were observed in areal and volumetric bone mineral density (BMD), microarchitecture, and strength between 7 and 40 months postpartum as assessed by dual-energy X-ray absorptiometry at the total hip and spine and by high-resolution peripheral quantitative CT at the distal radius and tibiae. At the hip, spine, and distal radius, these improvements were mainly enabled by treatment with TPTD and ZA, while at the distal tibiae, physiological recovery and postpartum physiotherapy due to leg pain after stumbling may have played a major role. Additionally, the findings show that, despite the improvements, BMD, microarchitecture, and strength remained severely impaired in comparison with healthy age- and gender-matched controls at 40 months postpartum. Genetic analysis showed no monogenic cause for osteoporosis, and it is suggested that PLO in this woman could have a polygenic origin with possible susceptibility based on familiar occurrence of osteoporosis.
Original languageEnglish
Pages (from-to)621-627
Number of pages7
JournalCalcified Tissue International
Issue number5
Early online date1 Feb 2023
Publication statusPublished - May 2023


  • Pregnancy- and lactation-associated osteoporosis
  • Teriparatide
  • Zoledronic acid
  • Bone microarchitecture
  • Bone strength
  • High-resolution peripheral quantitative computed tomography

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