产后骨质疏松症1例并文献复习

Postpregnacy osteoporosis

怀孕后骨质疏松症(postpregnacy osteoporosis)是中青年妇女在怀孕后合并的一种原发性骨质疏松症,自1955年Nordin首次报告以来可能还未引起足够的注意,至今报告仅80余例。由于约40%的患者在怀孕后期的最后三个月内出现背痛、身高缩短等症状、且大多数患者又在第一胎产后3个月出现椎体压缩性骨折,骨密度(BMD)减少主要局限于轴心骨(椎体、髋部),而外周骨BMD常属正常范围,故又称为孕后或产后椎体骨质疏松症(postpregnacy spinal osteoporosis,PPSO),其与另一类也发生在孕后仅局限在髋部的骨量减少、骨质疏松改变的所谓孕期暂时性髋部骨质疏松(transient osteoporosis of the hip in pregnancy,OHP)相区别。鉴于国内未有报道,现将1例产后椎体骨质疏松症结合文献讨论予以报告,以期引起临床关注。

A case of postpregancy osteoporosis is reported in a 31-year-old primiparous with severe vertebral fractures.The back pain was felling and getting worse after her delivery 45 to 68 days.9 vertebral fractures(T_6-T_(12), L_1,L_5) were showed by the radiological and MRI examination.The markers of bone turnover were showed at a abnormality high level including N-MIDBGP,β-CTX,B-ALP in serum and CTX/Cr,NTX/Cr,Ca/Cr in urine.Bone mineral density(BMD) was significantly decreased in the L_(1-4)、FN、Troch and total Hip.After 3 months,the symptomatic pain was quickly improved by calcitonin.BMD was significantly increased and bone markers were decreased in normal reference level after oral alendronate with supplement of calcium,vitamin D_3 for 1 year.The differential diagnosis and phatophysiology were discussed.