妊娠和哺乳期骨质疏松症并发腰椎骨折:病例报告及文献复习

Pregnancy and lactation-associated osteoporosis with lumbar fractures:case report and review of the literature

目的妊娠和哺乳期骨质疏松症(pregnancy and lactation-associated osteoporosis,PLO)是发于妊娠期和哺乳期的一种特发性的罕见的骨质疏松症,是多种因素影响骨代谢的结果。分析PLO的典型临床特征,以期进行早期的预防干预及诊疗。方法对在山东省中医院就诊的两名典型PLO患者的临床特点及治疗进行归纳总结,并结合文献对其临床特点、发病机制等方面进行分析。结果两名PLO患者均是在产后无明显诱因出现腰椎的剧烈腰痛,活动受限,并伴有腰椎的压缩性骨折,明确诊断后建议立即停止哺乳,两名患者均拒绝,予以中药、钙剂、维生素D等药物治疗,治疗后两名患者的症状均有明显改善。结论在妊娠和哺乳期间,未受明显外力的情况下出现突发性的严重腰痛患者应考虑PLO的可能,在确诊为PLO后,应建议立即停止哺乳,并予以中药、钙剂、维生素D、双膦酸盐类等药物治疗。

Objective Pregnancy and lactation-associated osteoporosis(PLO)is an idiopathic and rare osteoporosis that occurs during pregnancy and lactation.It is the result of multiple factors affecting bone metabolism.The typical clinical characteristics of PLO were analyzed in order to carry out early preventive intervention,diagnosis,and treatment.Methods The clinical characteristics and treatment of two typical PLO patients who were treated in Shandong Provincial Hospital of Traditional Chinese Medicine were summarized.Their clinical characteristics,pathogenesis,and other aspects were analyzed in combination with literature.Results Both patients with PLO developed severe lumbago,restricted mobility,and compression fractures of the lumbar spine after giving birth without obvious causes.It was recommended to stop breastfeeding immediately after the diagnosis was confirmed.Both patients refused to cease lactation.They received traditional Chinese medicine and calcium.After treatment with vitamin D and other drugs,the symptoms in both patients were significantly relieved.Conclusion During pregnancy and lactation,patients with sudden severe low back pain without significant external force should consider the possibility of PLO.After the diagnosis of PLO,it is recommended to stop breastfeeding immediately and to give Chinese medicine,calcium,vitamin D,and bisphosphonates,and other drugs.