妊娠哺乳相关骨质疏松症临床特点分析及文献复习  

Clinical characteristics of pregnancy and lactation-associated osteoporosis and literature review

作　　者：许莉军 张丽侠[1] 王志芳[1] 李冲[1] 张好好[1] 张会娟[1] 栗夏莲[1] 孙良阁[1] 郑丽丽[1] Xu Lijun;Zhang Lixia;Wang Zhifang;Li Chong;Zhang Haohao;Zhang Huijuan;Li Xialian;Sun Liangge;Zheng Lili(Department of Endocrinology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院内分泌科,450052

出　　处：《中华内分泌代谢杂志》2022年第10期900-905,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的:通过对本院9例妊娠哺乳相关性骨质疏松症(pregnancy and lactation-associated osteoporosis, PLO)的临床特点进行总结,并结合文献复习进行讨论,以提高临床医师对该病的认识。方法:收集2014年1月至2021年6月于郑州大学第一附属医院内分泌科住院的9例PLO患者的病史、实验室检查、骨密度测定、治疗药物及随访等临床资料。结果:9例PLO患者发病年龄中位数30岁(22~37岁),其主要表现为腰背部疼痛,其中1例患者妊娠7个月出现,8例患者产后出现,产后腰背痛出现时间中位数为2.5个月(0.5~7个月)。89%患者影像学发现椎体压缩性骨折,平均椎体骨折个数为4.6个。8例患者采用双能X线吸收测量仪(DXA)检测确定为骨质疏松,以腰椎骨密度明显降低为主,1例患者腰椎定量CT(quantitative CT)检测确定为骨量减少。9例患者确诊后均停止母乳喂养,给予钙剂和维生素D制剂,7例患者应用双膦酸盐,1例患者应用特立帕肽序贯地舒单抗治疗。所有患者腰背疼痛均有所缓解,缓解时间中位数为3个月(7 d~6个月)。8例患者经治疗后骨密度均有升高,腰椎骨密度升高更明显,所有患者无新发骨折发生。结论:对于妊娠晚期或哺乳期女性出现腰背部疼痛、身高变矮,应考虑到PLO的可能。及时诊断、早期治疗对于预防骨折、降低再骨折风险及改善预后至关重要。Objective To analyze nine cases of pregnancy and lactation-associated osteoporosis(PLO)along with a literature review to improve clinicians′knowledge of the disease.Methods We collected medical history,laboratory examination,bone mineral density(BMD)scan,treatment and follow-up data of 9 inpatients with PLO in the Endocrinology Department of the First Affiliated Hospital of Zhengzhou University from January 2014 to June 2021.Results The median age of onset of 9 patients with PLO was 30 years(22-37 years).All 9 patients presented low back pain,and the median time of low back pain after childbirth was 2.5 months(0.5-7 months).89%of the patients presented vertebral compression fractures,and the mean number of vertebral fractures was 4.6.Eight patients with PLO showed osteoporosis by dual X-ray absorpiometry(DXA)scan,and one patient showed bone loss by quantitative CT scan.Osteoporosis predominated in the trabecular bone.After the diagnosis,nine patients with PLO stopped breastfeeding and were given calcium and vitamin D preparations.Seven patients were given bisphosphonates and one patient was treated with teriparatide followed by denosumab.The back pain of all patients was relieved,with the median of relief time being 3 months(7 d-6 m).After treatment initiation,BMD was increased in eight patients,especially obvious in the lumbar spine.No new clinical fractures occurred during the follow-up.Conclusions For women with low back pain and shortened height in late pregnancy or breastfeeding,the possibility of PLO should be considered.Prompt diagnosis and early medical interventions are of utmost importance to reduce the risk of subsequent fractures and improve the prognosis.

关 键 词：骨质疏松 妊娠 哺乳 

分 类 号：R580[医药卫生—内分泌]