妊娠哺乳相关骨质疏松症5例并文献复习

Pregnancy and lactation-associated osteoporosis: five cases and review of literature

目的通过5例妊娠哺乳相关性骨质疏松症(pregnancy and lactation-associated osteoporosis,PLO)病例报道并复习相关文献,提高临床医师对PLO临床特征及治疗方法的深入认识。方法收集2011-2017年就诊于中国人民解放军总医院的5例PLO患者的临床表现、实验室检查、治疗药物及随访结果,并汇总目前我国已报道的21例PLO患者的治疗转归资料。结果 5例PLO患者均为青年女性,平素月经规律,妊娠晚期及哺乳早期出现腰背痛及活动障碍,生化检查基本正常,影像学检查示椎体骨密度降低为主伴多发压缩性骨折。诊断后立即停止哺乳,给予钙剂、维生素D、降钙素及双膦酸盐治疗1～6个月后,腰背疼痛明显减轻。文献报道的21例PLO患者发病年龄22～40岁(平均30. 24岁),骨折距产后平均为2. 2个月,平均椎体骨折个数为4. 6个;治疗药物主要是钙剂、维生素D及双膦酸盐,双膦酸盐的治疗疗程为6～48个月(平均20. 8个月),进行3周到4年的随访,均结局较好。结论 PLO临床罕见,发病机制尚不明确,早期诊断并停止哺乳,给予钙剂、维生素D、降钙素、双膦酸盐等药物治疗,多数预后良好,但要长期随访。

Objective To reported five cases of pregnancy and lactation-associated osteoporosis (PLO) and had a literature review to improve physician s understanding of PLO. Methods We collected clinical manifestations, laboratory examination, treatment, and follow-up results of 5 PLO patients treated in the General Hospital of the People s Liberation Army from 2011 to 2017. Clinical data of 21 patients with PLO reported in China were retrospectively analyzed. Results All the 5 PLO patients were young women, with regular menstruation, low back pain and limited mobility in the late pregnancy and early lactation. Biochemical examination was basically normal, and imaging examination showed decreased vertebral bone density with multiple compression fractures. Lactation was terminated after diagnosis and all the patients received treatment of calcium, activated vitamin D, calcitonin, and biphosphonates. The back pain disappeared during a 1-6 month follow-up. In domestic literature, 21 cases of PLO were reported with onset from 22 to 40 years old (mean age 30.24 years old). The average postpartum fracture time was 2.2 months, and the average number of vertebral fractures was 4.6. The main therapeutic drugs were calcium, vitamin D, and bisphosphonate, and the treatment course of bisphosphonate was 6 to 48 months (mean 20.8 months). All the patients were followed up for 3 weeks to 4 years and had a good outcome. Conclusions PLO is rare in clinic and its pathophysiology is not clear. Most PLO patients have a good prognosis by stopping breastfeeding and giving calcium, active vitamin D, calcitonin, bisphosphonates and other drugs, but they should be followed up for a long time.