CalciumNEW2026

Pregnancy and lactation-associated osteoporosis in a postpartum woman with twin pregnancy: a 5-year follow-up case report.

Adnan Hussain Muthasim, Gao Xiaoyun, Yu Xiuqi, Zhang Chunyu — Frontiers in endocrinology

Summary

This report highlights a rare bone condition called pregnancy and lactation-associated osteoporosis (PLO), which can cause severe back pain and bone fractures in some women after childbirth. It describes a case where a woman developed this condition after having twins and breastfeeding, emphasizing the importance of early diagnosis and treatment. The report suggests that factors like inadequate dietary intake, including calcium, can contribute to the risk.

AI-generated summary — read the original

Key points

Pregnancy and lactation-associated osteoporosis (PLO) is a rare bone condition that can affect women after childbirth.
Severe back pain in postpartum women, especially with risk factors like twin pregnancy or exclusive breastfeeding, warrants medical evaluation.
Inadequate dietary intake, including calcium, can be a contributing factor to PLO.
Early diagnosis and treatment, which may include calcium and vitamin D, can significantly improve bone health and symptoms.

What the study looked at

This report aimed to describe the clinical presentation, diagnostic challenges, and long-term outcomes of a rare bone condition called pregnancy and lactation-associated osteoporosis (PLO) in a specific patient. It highlighted how this condition can manifest and progress. This was a case report, focusing on a single 32-year-old woman who developed severe back pain two weeks after delivering twins via C-section. She was exclusively breastfeeding and reported not eating enough. Doctors followed her progress for five years after diagnosis and treatment. The woman was diagnosed with PLO after doctors found multiple fractures in her spine and very low bone density. Her bone health improved significantly over five years with treatment, which included medications like calcium and vitamin D, and her symptoms resolved. The case emphasized that factors like twin pregnancy, exclusive breastfeeding, and insufficient dietary intake (which can include calcium) might increase risk.

Dietary takeaway

While this is just one case study and not a definitive finding for everyone, it underscores the critical importance of adequate calcium intake, especially during pregnancy and breastfeeding. Ensuring you consume enough calcium-rich foods like dairy products, fortified plant-based milks, and leafy greens can support your bone health during these demanding periods. If you experience persistent severe back pain after childbirth, it's always wise to consult a healthcare professional.

Abstract

INTRODUCTION: Pregnancy and lactation-associated osteoporosis (PLO) is a rare but potentially disabling metabolic bone disorder that typically emerges in late pregnancy or the early postpartum period. Because its symptoms often present as common postpartum musculoskeletal complaints, diagnosis is frequently delayed until vertebral fractures are detected. This case report describes a postpartum woman with a twin pregnancy who developed multiple vertebral compression fractures, illustrating the diagnostic challenges, clinical features, and long-term outcomes of PLO. CASE PRESENTATION: A 32-year-old woman presented with persistent low back pain two weeks after cesarean delivery of twins. She had been exclusively breastfeeding and reported inadequate dietary intake and recent weight loss. Thoracolumbar MRI revealed acute compression fractures at T12, L1, and L5. Laboratory evaluation demonstrated low 25-hydroxyvitamin D and parathyroid hormone levels, markedly elevated β-CTX and P1NP, and elevated prolactin. DXA showed significantly reduced lumbar bone mineral density (Z-score -3.25). Clinically significant secondary causes of osteoporosis were excluded based on available testing, and PLO was diagnosed. She was treated with calcium carbonate, calcitriol, alfacalcidol, calcitonin, and intravenous zoledronic acid (initial 5 mg dose during admission, with a second 5 mg dose administered at 1-year follow-up). Following treatment, biochemical markers normalized. At follow-up, MRI confirmed fracture healing, DXA demonstrated improved bone mineral density, and the patient reported complete resolution of symptoms. Long-term evaluation at 5 years showed sustained clinical stability and continued improvement in BMD. CONCLUSION: This case highlights the importance of considering PLO in postpartum women with severe back pain, particularly in the presence of risk factors such as low BMI, inadequate calcium intake, vitamin D insufficiency, exclusive breastfeeding, and twin pregnancy. Early recognition and management can prevent prolonged morbidity and support continued improvement in bone health.

View on PubMed →DOI: 10.3389/fendo.2026.1931693