Case description: A 40-year-old gravida 2 para 1 woman presented with atraumatic pain in her left hip and right mid foot seven days postpartum on the background of a previous subchondral insufficiency fracture (SIF) of the right femoral head diagnosed in second trimester of her pregnancy and was managed conservatively with non-weight bearing. Her medical history included previous stress fracture of the right hip in 2012. Magnetic resonance imaging (MRI) demonstrated a nondisplaced subchondral insufficiency fracture of the left femoral head with bone marrow oedema and a possible early stress fracture of the right fifth metatarsal bone. Bone mineral density (BMD) demonstrated low Z scores (Lumbar spine -1.3, Right femoral neck -2.1, left femoral neck -1.3). Screen for secondary causes of osteoporosis was unremarkable. A diagnosis of pregnancy and lactation associated osteoporosis (PLO) was made. The patient was managed conservatively with no weight bearing on her left hip. Follow up at six months postpartum showed complete resolution of her symptoms.
Discussion: PLO is a rare condition in pregnant and postpartum women and is infrequently associated with fragility fractures in sites such as the vertebrae, hips, ankle or wrist [1–4]. Its pathophysiology is poorly defined. The involvement of multiple fracture sites in our patient suggest a global process. Diagnosis is often challenging as presentation with pelvic and hip pain in pregnancy are common and often attributed to soft tissue injury, arthritic pain or symphysis pubis dysfunction. MRI is the gold standard diagnostic method. Management includes conservative approaches such as non/reduced weight bearing with regular analgesia during pregnancy, bisphosphonate therapy postpartum and surgical interventions such as reduction and internal fixation of fracture or arthroplasty.
Reference
[1] G. Wang, X. Bai, Barton Fracture of the Distal Radius in Pregnancy and Lactation-Associated Osteoporosis: A Case Report and Literature Review, International Journal of General Medicine. 13 (2020) 1043–1049. https://doi.org/10.2147/ijgm.s278536.
[3] P. Sachsanidis, M.V. Tartagni, U. Graf, Recurrent Transient Osteoporosis during Pregnancy and Treatment with Oral Bisphosphonates: A Case Report, Open Journal of Obstetrics and Gynecology. 07 (2017) 1044–1051. https://doi.org/10.4236/ojog.2017.710105.
[4] Y. Nakamura, M. Kamimura, S. Ikegami, K. Mukaiyama, M. Komatsu, S. Uchiyama, H. Kato, A case series of pregnancy- and lactation-associated osteoporosis and a review of the literature, Therapeutics and Clinical Risk Management. (2015) 1361. https://doi.org/10.2147/tcrm.s87274.