8605 Effective Strategies For Pregnancy And Lactation-Associated Osteoporosis: Teriparatide Use In Focus

Disclosure: D.S. Ali: None. A.A. Khan: Advisory Board Member; Self; Amgen Inc, Alexion, Ascendis. Grant Recipient; Self; Takeda, Amolyt, Calcilytix. Speaker; Self; Amgen Inc, Alexion. M. Brandi: Consulting Fee; Self; Aboca, Alexion, Amolyt, Bruno Farmaceutici, Calcilytix, Echolight, Kyowa Kirin, Personal Genomics, UCB. Speaker; Self; Abiogen, Alexion, Amolyt, Amorphical, Bruno Farmaceutici, CoGeDi, Echolight, Amgen Inc, Eli Lilly & Company. Background: Pregnancy and lactation-associated osteoporosis (PLO) is a rare but debilitating condition characterized by fragility fractures occurring during late pregnancy or during lactation, primarily affecting the spine. Current treatment strategies lack clear guidance on optimal management due to the absence of clinical trials. Previous treatment strategies focused on conventional measures such as the use of calcium supplements, vitamin D, back braces, and weaning from breastfeeding. Antiresorptive therapies have also been used. The use of teriparatide (TPD) in PLO has gained more attention in the past decade due to its anabolic properties and potential suitability for women of childbearing age. Methods: We searched PubMed, Google Scholar, and Medline until August 2023. Over 300 cases with PLO have been published. We included cases with a confirmed diagnosis of PLO based on clinical history and radiographic confirmation. Cases with prior fragility fractures, traumatic fractures or prior diagnosis of osteoporosis have been excluded. Results: We identified a total of 175 cases of PLO treated with either TPD alone or TPD followed by antiresorptive therapy. We also identified another cohort of 81 women where separation of those receiving TPD from other treatment was not possible. Most women in our analysis were primiparas (85.7%). The duration of TPD use ranged from 4 to 24 months. Despite the acknowledged risk of recurrent fractures in PLO, 82.8% of those treated with TPD did not sustain new fractures during a follow-up period ranging from 4 months to 9 years. Although direct treatment comparative studies are lacking, available evidence suggests that TPD treatment significantly improves bone mineral density (BMD) at the spine (33% at 24 months) and hip (18.6% at 18-24 months). Bisphosphonates, demonstrate varying degrees of BMD improvement. Bone turnover markers such as C-telopeptide cross-linked type I collagen (CTx) and osteocalcin have been studied in patients with PLO, suggesting that they may be predictive of BMD response to TPD treatment. Conclusion: This review highlights the severity of PLO and its health consequences, advocates for increased awareness and timely interventions. TPD emerges as a promising therapeutic option, offering substantial BMD responses and potentially serving as the primary choice for PLO treatment, given its safety profile and short half-life. Especially with consideration of the potential long-term effects associated with bisphosphonate use in women of childbearing age. Use of BTMs need further validation. Presentation: 6/3/2024