{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:01:01Z","timestamp":1781265661078,"version":"3.54.1"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":162,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Obstetrics and Gynecology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pregnancy\u2010 and lactation\u2010associated osteoporosis (PLO) is a rare condition that may cause multiple vertebral fractures during late pregnancy or the postpartum period. Evidence regarding treatment strategies remains limited, particularly regarding long\u2010term outcomes of sequential regimens combining anabolic and antiresorptive therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 37\u2010year\u2010old woman developed low back pain 3 months postpartum and was diagnosed with PLO accompanied by multiple acute and chronic vertebral fractures. Breastfeeding was discontinued, and initial treatment with vitamin D analogs and bisphosphonate therapy was selected based on clinical and patient\u2010specific considerations, including documented efficacy in PLO, the absence of reproductive safety concerns, and patient preferences. Despite early improvement, lumbar spine Z\u2010score remained persistently low at \u22123.0, and therapy was sequentially transitioned to daily teriparatide for 2 years, romosozumab for 1 year, and denosumab for maintenance. Over 5 years and 7 months, lumbar spine and femoral neck bone mineral density increased by 53.4% and 26.1%, respectively. No new fractures occurred, and serial bone turnover markers demonstrated appropriate anabolic and antiresorptive responses at each phase of therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights a successful long\u2010term sequential treatment strategy for PLO involving bisphosphonate, teriparatide, romosozumab, and denosumab in a patient without desire for further pregnancy, without reproductive safety constraints. The individualized sequential approach developed through patient education and shared decision\u2010making may help achieve sustained improvements in bone mineral density and prevent refracture in patients at very high fracture risk, particularly when an anabolic\u2010first strategy is not initially feasible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crog\/5696865","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T11:51:52Z","timestamp":1781265112000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010Term Sequential Therapy for Pregnancy\u2010 and Lactation\u2010Associated Osteoporosis With Multiple Vertebral Fractures: A Case Report of Over 5 Years"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8927-7664","authenticated-orcid":false,"given":"Kaneyuki","family":"Tsuchimochi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5641-1406","authenticated-orcid":false,"given":"Hiroe","family":"Tsuchimochi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S366254"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1494965"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13091615"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S107285"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8836583"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/jbmr\/zjae119"},{"key":"e_1_2_13_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-011-1816-z"},{"key":"e_1_2_13_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/1759720X241259897"},{"key":"e_1_2_13_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbm4.10546"},{"key":"e_1_2_13_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2020.115574"},{"key":"e_1_2_13_11_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59010019"},{"key":"e_1_2_13_12_2","doi-asserted-by":"publisher","DOI":"10.21037\/acr-24-163"},{"key":"e_1_2_13_13_2","doi-asserted-by":"crossref","DOI":"10.1093\/jbmrpl\/ziae131","article-title":"Therapy With Transitions From One Bone-Forming Agent to Another: A Retrospective Cohort Study on Teriparatide and Romosozumab","volume":"8","author":"Kobayakawa T.","year":"2024","journal-title":"JBMR Plus"},{"key":"e_1_2_13_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.3337"},{"key":"e_1_2_13_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2021.115911"},{"key":"e_1_2_13_16_2","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S30668"},{"key":"e_1_2_13_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-017-4239-1"}],"container-title":["Case Reports in Obstetrics and Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crog\/5696865","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crog\/5696865","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crog\/5696865","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T11:51:54Z","timestamp":1781265114000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crog\/5696865"}},"subtitle":[],"editor":[{"given":"Dani","family":"Ejzenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/crog\/5696865"],"URL":"https:\/\/doi.org\/10.1155\/crog\/5696865","archive":["Portico"],"relation":{},"ISSN":["2090-6684","2090-6692"],"issn-type":[{"value":"2090-6684","type":"print"},{"value":"2090-6692","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-12-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"5696865"}}