Pregnancy and Lactation Associated Osteoporosis in a 24-Year-Old Presenting with Multiple Fragility Fractures in the Dorsolumbar Spine: A Case Report and Review of Literature.

Introduction: Osteoporosis is rare in the young having an incidence of 4.1 per 100,000 person-years and can occur secondary to endocrine diseases, inflammatory disorders, malnutrition or malabsorption syndromes, and medications. Pregnancy and lactation-associated osteoporosis (PLO) should be thought of as one of the causes but is often missed as the diagnosis requires a high degree of suspicion along with X-rays and densitometry which are avoided as far as possible during the peripregnancy period. If missed, it can lead to osteoporotic fractures and disability.

Case Report: We report a case of a 24-year-old primigravida presenting with low back pain 4 months after pregnancy having multiple vertebral compression fractures. On initial workup, a diagnosis of osteoporosis was made and causes of secondary osteoporosis were ruled out after radiological and laboratory investigations. A diagnosis of PLO was made after exclusion of other possible causes. The patient was treated with cessation of lactation and medical management in the form of Calcitonin, Teriparatide, Vitamin D, and calcium supplementation. The patient was symptom-free after 12 months.

Conclusion: Through this case report, we hope to emphasize that PLO should be considered as a possible etiology in young females with multiple atraumatic fragility fractures presenting in the peri-pregnancy period.