Comparison of Efficacy of Pharmacologic Treatments in Pregnancy- and Lactation-Associated Osteoporosis

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare disorder characterised by the occurrence of multiple fragility fractures, particularly at vertebral columns, in the third trimester or early postpartum period. Whether implementation for pharmacologic treatments in patients with PLO remains controversial partly due to rarity of data and known indolent recovery of bone mass after fracture, various pharmacologic treatments have been reported to effectively facilitate bone mineral density (BMD) increase in anecdotal case reports or cohorts based on individualised clinical assessment of subsequent fracture risk. In this study, we aimed to summarise pharmacologic strategies and its efficacy on BMD change and subsequent fractures using individual case data or frequency-weighted group data from available literatures. Among 2438 studies identified using PubMed and Embase until Jan 2019, 30 studies which reported pharmacologic treatment (23 studies) or observation (7 studies) were included. Reported treatment options consisted of observation with calcium/vitamin D supplements (control, n = 32), bisphosphonates (BP, n = 31), teriparatide (TPTD, n = 40) and other strategies (vitamin K2 and strontium; other, n = 4). Median treatment duration and BMD follow-up duration was 27 and 35 months, respectively. Mean lumbar spine BMD measured by dual-energy x-ray absorptiometry was increased at 3-year follow-up in all groups (control, 7.9%; BP, 18.2%; TPTD, 17.0%; other, 8.6%; P < 0.05 for all), with significantly higher BMD change in BP or TPTD compared to control (Bonferroni-corrected P < 0.001 for all). Our findings suggest the potential long-term efficacy of pharmacologic treatments in individuals with PLO with high risk of subsequent fracture.