Abstract：
Pregnancy- and lactation-associated osteoporosis (PLO) is a rare type of premenopausal osteoporosis that occurs mainly in the third trimester or immediately after delivery; one of its most common symptoms is back pain caused by a vertebral fracture. The pathogenesis of PLO is unclear, and there is no accepted consensus regarding the treatment of PLO. Although treatments with drugs such as bisphosphonate, strontium ranelate, denosumab, and teriparatide were reported, there is no report of a patient with PLO treated with romosozumab. We present the first case of a patient with PLO treated with romosozumab following 4-month teriparatide treatment. A 34-year-old primiparous and breastfeeding Japanese woman experienced severe low back pain 1 month postdelivery. She was diagnosed with PLO on the basis of low bone marrow density (BMD) and multiple vertebral fractures with no identified cause of secondary osteoporosis. She was treated with teriparatide injection for 4 months, but the treatment was discontinued because of the patient feeling severe nausea after every teriparatide injection and the appearance of new vertebral fractures. Thereafter, we used romosozumab for 12 months. After the romosozumab treatment, her BMD was increased from the baseline by 23.6% at L1-L4, 6.2% at the femoral neck, and 11.2% at the total hip. Treating PLO with 12-month romosozumab after 4 months of teriparatide injection remarkably increased the BMD of the lumbar spine, femoral neck, and total hip without subsequent fracture. Romosozumab has potential as a therapeutic option to improve the BMD and reduce the subsequent fracture risk of patients with PLO.
摘要：
妊娠和哺乳相关的骨质疏松症（PLO）是一种罕见的绝经前骨质疏松症，主要发生在妊娠晚期或分娩后立即；其最常见的症状之一是椎骨骨折引起的背痛。PLO的发病机制尚不清楚,关于巴解组织的治疗没有公认的共识。虽然用双膦酸盐等药物治疗，雷奈酸锶,denosumab,和特立帕肽被报告，尚无PLO患者接受romosozumab治疗的报告.我们介绍了第一例接受romosozumab治疗的PLO患者，经过4个月的特立帕肽治疗。一名34岁的初产和母乳喂养的日本妇女在分娩后1个月经历了严重的腰痛。由于骨髓密度（BMD）低和多发性椎骨骨折，没有发现继发性骨质疏松症的原因，她被诊断为PLO。她接受了注射特立帕肽治疗4个月，但由于每次注射特立帕肽后患者都感到严重恶心，并出现新的椎骨骨折，因此停止了治疗。此后,我们使用romosozumab治疗了12个月.在romosozumab治疗后,她的骨密度从基线增加了23.6%在L1-L4，6.2%在股骨颈，全髋关节占11.2%。使用12个月的romosozumab治疗PLO，在注射特立帕肽4个月后显著增加腰椎的BMD，股骨颈,全髋关节无骨折。Romosozumab具有作为改善BMD和降低PLO患者后续骨折风险的治疗选择的潜力。
