Schwangerschaftsosteoporose

Zusammenfassung

Eine Schwangerschaftsosteoporose ist selten. Da sie aber gelegentlich zu Insuffizienzfrakturen führt, muss beim Auftreten von diffusen muskuloskelettalen Schmerzen in der Schwangerschaft, insbesondere bei Rückenschmerzen und unklaren Schmerzen an der unteren Extremität, als Differenzialdiagnose an sie gedacht werden. Therapieempfehlungen und allgemeine Präventionsempfehlungen existieren nicht. Anhand von drei Fällen wird auch die Möglichkeit einer medikamentösen Therapie mit Parathormon (Teriparatid) diskutiert. Bei diesen drei vorgestellten Patientinnen mit Schwangerschaftsosteoporose mit Wirbelfrakturen oder Frakturen an anderen Lokalisationen während oder kurz nach der Schwangerschaft führte Teriparatid zu einer Zunahme der Knochendichte und scheint insofern möglicherweise wirksam zu sein.

Summary

Pregnancy-associated osteoporosis is a rare condition. Sometimes it leads to insufficiency fractures. We must consider pregnancy-associated osteoporosis as a differential diagnosis in diffuse muskuloskeletal pain, especially back pain and pain of lower extremity. There are no general recommendations for therapy and prevention. We present three cases and also discuss an optional novel therapy with teriparatid. In the presented three cases teriparatid seems to be effective and leads to an increase in bone density.

Schlüsselwörter

Schwangerschaftsosteoporose - Insuffizienzfrakturen - Teriparatid

Keywords

Preganc-associated osteoporosis - insufficiency fractures - Teriparatid

• Literatur

• 1 Aguado F. et al. Ultrasonographic bone velocity in pregnancy: a longitudinal study. Am J Obstet Gynecol 1998; 178: 1016-1021.
• 2 Barkmann R. et al. A new method for quantitative ultrasound measurements at multiple skeletal sites: first results of precision and fracture discrimination. J Clin Densitom 2000; 03: 1-7.
• 3 Bietenhard K. et al. Transiente Osteoporose während der Schwangerschaft. Praxis 2001; 90: 805-807.
• 4 Bijl M. et al. Transient osteoporosis of the hip: presentation of (a)typical cases and are view of the literature. Clin Exp Rheumatol 1999; 17 (05) 601-604.
• 5 Chan GM. et al. Bone mineral status of lactating mothers of different ages. Am J Obstet Gynecol 1982; 144: 438-441.
• 6 Ensom MH. et al. Effect of pregnancy on bone mineral density in healthy women. Obstet Gynecol. Surv 2002; 57: 99-111.
• 7 Gallacher SJ. et al. Changes in calciotrophic hormones and biochemical markers of bone turnover in normal human pregnancy. Eur J Endocrinol 1994; 131: 369-374.
• 8 Gluer CC. et al. Quantitative ultrasonic diagnosis for the assessment of osteoporosis. Z Arztl Fortbild Qualitatssich 2000; 94: 461-468.
• 9 Hadji P. et al. Quantitative ultrasound of the os calcis in postmenopausal women with spine and hip fracture. J Clin Densitom 2000; 03: 233-239.
• 10 Haram K. et al. Calcium homeostasis in pregnancy and lactation. Acta Obstet Gynecol Scand 1993; 72: 509-513.
• 11 Javaid M. et al. Late pregnancy serum vitamin D and longitudinal bone loss during pregnancy: The southampton womens survey. 2008; Abstract F 544.
• 12 Karlsson MK. et al. Maternity and bone mineral density. Acta Orthop 2005; 76: 2-13.
• 13 Kent GN. et al. Human lactation: forearm trabecular bone loss, increased bone turnover, and renal conservation of calcium and inorganic phosphate with recovery of bone mass following weaning. J Bone Miner Res 1990; 05: 361-369.
• 14 Kovacs CS, Fuleihan Gel-H. Calcium and bone disorders during pregnancy and lactation.Calcium and bone disorders during pregnancy and lactation. Endocrinol Metab Clin North Am 2006; 35: 21-51.
• 15 Kovacs CS, Kronenberg HM. Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation. Endocr rev 1997; 18: 832-872.
• 16 Purdie DW. et al. Bone histology and mineral homeostasis in human pregnancy. Br J Obstet Gynaecol 1988; 09: 849-854.
• 17 Reid IR. The skeleton in pregnancy and lactation. Intern Med J 2002; 32: 433-434.
• 18 Smith R. et al. Pregnancy associated osteoporosis. Q J Med 1995; 88: 865-878.
• 19 Sowers MF. Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 1996; 11: 1052-1060.
• 20 Sowers M. et al. Changes in bone density with lactation. JAMA 1993; 269: 3130-3135.
• 21 Wüster C. et al. Phalangeal osteosonogrammetry study: age-related changes, diagnostic sensitivity, and discrimination power. The Phalangeal Osteosonogrammetry Study Group. J Bone Miner Res 2000; 15: 1603-1614.
• 22 Yamaga A. et al. Changes in bone mass as determined by ultrasound and biochemical markers of bone turnover during pregnancy and puerperium: a longitudinal study. J Clin Endocrinol Metab 1996; 81: 752-756.