{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:47Z","timestamp":1787721647261,"version":"build-2784847793"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>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 \u03b2-CTX and P1NP, and elevated prolactin. DXA showed significantly reduced lumbar bone mineral density (Z-score \u22123.25). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1931693","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:48:17Z","timestamp":1787719697000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pregnancy and lactation-associated osteoporosis in a postpartum woman with twin pregnancy: a 5-year follow-up case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Hussain Muthasim","family":"Adnan","sequence":"first","affiliation":[{"name":"Department of Geriatrics, The Second Affiliated Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyun","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, The Second Affiliated Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuqi","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, The Second Affiliated Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, The Second Affiliated Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S366254","article-title":"Recent insights into pregnancy and lactation-associated osteoporosis (PLO)","volume":"15","author":"Scioscia","year":"2023","journal-title":"Int J Womens Health"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.19011","article-title":"Analysis of fracture incidence in 135 patients with pregnancy and lactation osteoporosis (PLO)","volume":"13","author":"Miles","year":"2021","journal-title":"Cureus"},{"key":"B3","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1152\/physrev.00027.2015","article-title":"Maternal mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery","volume":"96","author":"Kovacs","year":"2016","journal-title":"Physiol Rev"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13091615","article-title":"Bridging the gap: Pregnancy-and lactation-associated osteoporosis","volume":"13","author":"Carsote","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvaf126","article-title":"Pregnancy and lactation associated bone fragility","volume":"9","author":"Kovacs","year":"2025","journal-title":"J Endocr Soc"},{"key":"B6","article-title":"Calcium and phosphate metabolism and related disorders during pregnancy and lactation","volume-title":"Endotext","author":"Kovacs","year":"2024"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2021.115911","article-title":"Relevant genetic variants are common in women with pregnancy and lactation-associated osteoporosis (PLO) and predispose to more severe clinical manifestations","volume":"147","author":"Butscheidt","year":"2021","journal-title":"Bone"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000008671","article-title":"Approach to the patient with pregnancy and lactation-associated osteoporosis: A case report and a review of the literature","volume":"96","author":"Zhang","year":"2017","journal-title":"Med (Baltimore)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1177\/15563316231167148","article-title":"Rehabilitation of pregnancy and lactation-associated osteoporosis and vertebral fractures: A case report","volume":"20","author":"Sahni","year":"2024","journal-title":"HSS J"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1530\/EC-20-0055","article-title":"Pregnancy and lactation, a challenge for the skeleton","volume":"9","author":"Winter","year":"2020","journal-title":"Endocr Connect"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/nu13093071","article-title":"25 years of research in human lactation: From discovery to translation","volume":"13","author":"Geddes","year":"2021","journal-title":"Nutrients"},{"key":"B12","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1016\/j.bjan.2019.08.004","article-title":"Calcitonina como agente analg\u00e9sico: revis\u00e3o dos mecanismos de a\u00e7\u00e3o e das aplica\u00e7\u00f5es cl\u00ednicas [Calcitonin as an analgesic agent: review of mechanisms of action and clinical applications","volume":"69","author":"Yazdani","year":"2019","journal-title":"Braz J Anesthesiol"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1931693\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:48:29Z","timestamp":1787719709000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1931693\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":12,"alternative-id":["10.3389\/fendo.2026.1931693"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1931693","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1931693"}}