{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:03:42Z","timestamp":1789621422451,"version":"build-2803163510"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"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":"\n Background<\/jats:title>\n Pregnancy and lactation-associated osteoporosis (PLO) is an uncommon cause of fragility fractures in young women, and the optimal treatment strategy remains unclear. This study aimed to investigate the clinical features, treatment approaches, and bone mineral density (BMD) outcomes of women with PLO across multiple centers in T\u00fcrkiye.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This multicenter retrospective cohort study included 59 women with PLO from 18 endocrine centers in T\u00fcrkiye. Data on demographics, clinical and laboratory results, fractures, treatments, and bone density were collected. Changes in the lumbar spine, femoral neck, and total hip BMD were tracked. Additionally, lumbar spine BMD outcomes were compared between women who received teriparatide and those managed with calcium\/vitamin D alone.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The mean age at diagnosis was 29.1 \u00b1 4.8 years. Overall, 86.4% of patients had vertebral fractures, and 67.8% had multiple fractures. Of the 59 patients, 10 received bisphosphonates, 3 received denosumab, 22 received TPTD, and 24 received calcium\/vitamin D supplementation alone as first-line treatment. Lumbar spine BMD improved significantly in all treatment groups and total hip BMD in the teriparatide and calcium\/vitamin D groups, whereas femoral neck BMD improved significantly only in the teriparatide group. Women receiving TPTD demonstrated greater early improvement in lumbar spine BMD than those managed with calcium\/vitamin D alone (19.1% vs 9.5%; Hodges\u2013Lehmann median difference, 11.5 percentage points [95% CI, 1.5 to 22.8]; P\u00a0=\u00a00.019). However, the between-group difference in lumbar spine BMD improvement was no longer significant at the second follow-up. After adjustment for baseline lumbar spine BMD, age, BMI and multiple vertebral fractures, treatment group was no longer independently associated with early lumbar spine BMD change (B\u00a0=\u00a03.0 percentage points, 95% CI \u221212.8 to 18.9; P\u00a0=\u00a00.698).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Women with PLO showed substantial recovery in bone density during follow-up across treatment groups. Although women receiving TPTD demonstrated greater early lumbar spine BMD improvement in unadjusted analyses, this association was not independent after multivariable adjustment, and between-group differences were no longer observed during later follow-up. Prospective comparative studies are needed to define the optimal treatment strategy.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fendo.2026.1934166","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:29:22Z","timestamp":1789619362000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world treatment outcomes in pregnancy and lactation-associated osteoporosis: a nationwide multicenter cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Mehmet","family":"S\u00f6zen","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine","place":["Kocaeli, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep","family":"Cant\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine","place":["Kocaeli, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zen","family":"\u00d6z G\u00fcl","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Uludag University Faculty of Medicine","place":["Bursa, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa Sait","family":"G\u00f6nen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hande Mefkure","family":"\u00d6zkaya","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serhat","family":"Uysal","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra \u015e\u00fcheda","family":"Hatipo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Health Sciences, Basaksehir Cam and Sakura City Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rukiye Dilara Tekin","family":"Uzman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Health Sciences, Basaksehir Cam and Sakura City Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aysen","family":"Akal\u0131n","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Osmangazi University Faculty of Medicine","place":["Eski\u015fehir, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erman","family":"\u00c7akal","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ankara Etlik City Hospital","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6knur","family":"Yorulmaz","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Osmangazi University Faculty of Medicine","place":["Eski\u015fehir, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sema","family":"Hep\u015fen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ankara Etlik City Hospital","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Banu Kara","family":"K\u0131van\u00e7","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Osmangazi University Faculty of Medicine","place":["Eski\u015fehir, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neslihan","family":"Kurtulmu\u015f","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Acibadem Maslak Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zlem Zeynep","family":"Akyay","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Nev Hospital","place":["\u015eanl\u0131urfa, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeliha","family":"Hekimsoy","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Celal Bayar University Faculty of Medicine","place":["Manisa, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zlem Turhan","family":"\u0130yidir","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ba\u015fkent University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma Ela","family":"Keskin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Demiroglu Bilim University Faculty of Medicine","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynel Abidin","family":"Sayiner","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Gaziantep University Faculty of Medicine","place":["Gaziantep, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ay\u015fe Kubat","family":"\u00dcz\u00fcm","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Istanbul University Faculty of Medicine","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilg\u0131n Y\u0131ld\u0131r\u0131m","family":"\u015eim\u015fir","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ege University Faculty of Medicine","place":["\u0130zmir, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ceyla Konca","family":"Degertekin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ufuk University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6mercan","family":"Topalo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Zonguldak B\u00fclent Ecevit University Faculty of Medicine","place":["Zonguldak, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevde Nur","family":"F\u0131rat","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ankara Education and Research Hospital","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damla","family":"K\u00f6ksalan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Derince Education and Research Hospital","place":["Kocaeli, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berrin","family":"\u00c7etinarslan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine","place":["Kocaeli, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alev","family":"Selek","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine","place":["Kocaeli, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"Gezer","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine","place":["Kocaeli, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saadet","family":"Acar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine","place":["Kocaeli, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Batman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Acibadem Mehmet Ali Aydinlar University Faculty of Medicine","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"B1","unstructured":"Recent insights into pregnancy and lactation-associated osteoporosis (PLO)\n \n \n \n Scioscia\n MF\n \n \n Zanchetta\n MB\n \n \n \n 2023"},{"key":"B2","unstructured":"Osteoporosis in young adults: pathophysiology, diagnosis, and management\n \n \n \n Ferrari\n S\n \n \n Bianchi\n ML\n \n \n Eisman\n JA\n \n \n Foldes\n AJ\n \n \n Adami\n S\n \n \n Wahl\n DA\n \n \n \n 2012"},{"key":"B3","unstructured":"Pregnancy and lactation-associated osteoporosis as a major type of premenopausal osteoporosis: a retrospective cohort study based on real-world data\n \n \n \n Kasahara\n K\n \n \n Tanaka-Mizuno\n S\n \n \n Tsuji\n S\n \n \n Ohashi\n M\n \n \n Kasahara\n M\n \n \n Kawasaki\n T\n \n \n \n 2024"},{"key":"B4","unstructured":"Elevated parathyroid hormone-related peptide associated with lactation and bone density loss\n \n \n \n Sowers\n MF\n \n \n Hollis\n BW\n \n \n Shapiro\n B\n \n \n Randolph\n J\n \n \n Janney\n CA\n \n \n Zhang\n D\n \n \n \n 1996"},{"key":"B5","unstructured":"The role of PTHrP in regulating mineral metabolism during pregnancy, lactation, and fetal\/neonatal development\n \n \n \n Kovacs\n CS\n \n \n \n 2014"},{"key":"B6","unstructured":"Maternal mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery\n \n \n \n Kovacs\n CS\n \n \n \n 2016"},{"key":"B7","unstructured":"Clinical presentation, risk factors and management of pregnancy-associated osteoporosis: a systematic review and meta-analysis\n \n \n \n Orhadje\n E\n \n \n Makaram\n N\n \n \n Berg\n K\n \n \n Hauser\n B\n \n \n Ralston\n SH\n \n \n \n 2025"},{"key":"B8","unstructured":"Identifying risk factors for pregnancy and lactation-associated osteoporosis: insights from an Italian survey in PLAO patients and controls\n \n \n \n Grassi\n G\n \n \n Zampogna\n M\n \n \n Atlasova\n A\n \n \n Rondinella\n S\n \n \n Ghielmetti\n A\n \n \n Siracusano\n G\n \n \n \n 2025"},{"key":"B9","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":"B10","unstructured":"Effective strategies for pregnancy and lactation-associated osteoporosis: teriparatide use in focus\n \n \n \n Ali\n DS\n \n \n Khan\n AA\n \n \n Brandi\n ML\n \n \n \n 2024"},{"key":"B11","unstructured":"Dilemmas in the management of osteoporosis in younger adults\n \n \n \n Herath\n M\n \n \n Cohen\n A\n \n \n Ebeling\n PR\n \n \n Milat\n F\n \n \n \n 2022"},{"key":"B12","unstructured":"Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services\n \n \n \n Lems\n WF\n \n \n Paccou\n J\n \n \n Zhang\n J\n \n \n Fuggle\n NR\n \n \n Chandran\n M\n \n \n Harvey\n NC\n \n \n \n 2021"},{"key":"B13","doi-asserted-by":"publisher","first-page":"101437","DOI":"10.1016\/j.jocd.2023.101437","article-title":"DXA reporting updates: 2023 official positions of the International Society for Clinical Densitometry","volume":"27","author":"Krueger","year":"2024","journal-title":"J Clin Densitometry"},{"key":"B14","unstructured":"Pregnancy-related fractures: a retrospective study of a French cohort of 52 patients and review of the literature\n \n \n \n Laroche\n M\n \n \n Talibart\n M\n \n \n Cormier\n C\n \n \n Roux\n C\n \n \n Guggenbuhl\n P\n \n \n Degboe\n Y\n \n \n \n 2017"},{"key":"B15","unstructured":"Heparin-induced osteoporosis\n \n \n \n Nelson-Piercy\n C\n \n \n \n 1998"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2016.05.016","article-title":"Prolonged low-molecular-weight heparin use during pregnancy and subsequent bone mineral density","volume":"143","author":"Galambosi","year":"2016","journal-title":"Thromb Res"},{"key":"B17","unstructured":"Pregnancy- and lactation-associated osteoporosis with vertebral fractures: a systematic review\n \n \n \n Qian\n Y\n \n \n Wang\n L\n \n \n Yu\n L\n \n \n Huang\n W\n \n \n \n 2021"},{"key":"B18","unstructured":"Prospective observational study of bone mineral density during pregnancy: low molecular weight heparin versus control\n \n \n \n Carlin\n AJ\n \n \n Farquharson\n RG\n \n \n Quenby\n SM\n \n \n Topping\n J\n \n \n Fraser\n WD\n \n \n \n 2004"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1494965","article-title":"Current and future perspectives on pregnancy and lactation-associated osteoporosis","volume":"15","author":"Gak","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B20","unstructured":"Severe bone microarchitecture impairment in women with pregnancy and lactation-associated osteoporosis\n \n \n \n Scioscia\n MF\n \n \n Vidal\n M\n \n \n Sarli\n M\n \n \n Guelman\n R\n \n \n Danilowicz\n K\n \n \n Mana\n D\n \n \n \n 2021"},{"key":"B21","unstructured":"2023 annual meeting of the American Society for Bone and Mineral Research, Vancouver, BC, October 13\u201316, 2023\n \n \n \n Agarwal\n S\n \n \n Lang\n T\n \n \n Kamanda-Kosseh\n M\n \n \n El-Najjar\n D\n \n \n Bucovsky\n M\n \n \n Colon\n I\n \n \n \n 2023"},{"key":"B22","unstructured":"Bisphosphonates in pregnancy and lactation-associated osteoporosis\n \n \n \n O\u2019Sullivan\n SM\n \n \n Grey\n AB\n \n \n Singh\n R\n \n \n Reid\n IR\n \n \n \n 2006"},{"key":"B23","unstructured":"Clinical features, incidence and treatment outcome in pregnancy-associated osteoporosis: a single-centre experience over two decades\n \n \n \n Orhadje\n E\n \n \n Berg\n K\n \n \n Hauser\n B\n \n \n Ralston\n SH\n \n \n \n 2023"},{"key":"B24","unstructured":"Comparative effectiveness of therapeutic interventions in pregnancy and lactation-associated osteoporosis: a systematic review and meta-analysis\n \n \n \n Anagnostis\n P\n \n \n Lampropoulou-Adamidou\n K\n \n \n Bosdou\n JK\n \n \n Trovas\n G\n \n \n Galanis\n P\n \n \n Chronopoulos\n E\n \n \n \n 2024"},{"key":"B25","unstructured":"Teriparatide treatment in patients with pregnancy- and lactation-associated osteoporosis\n \n \n \n Lampropoulou-Adamidou\n K\n \n \n Trovas\n G\n \n \n Triantafyllopoulos\n IK\n \n \n Yavropoulou\n MP\n \n \n Anastasilakis\n AD\n \n \n Anagnostis\n P\n \n \n \n 2021"},{"key":"B26","unstructured":"Bone density after teriparatide discontinuation with or without antiresorptive therapy in pregnancy- and lactation-associated osteoporosis\n \n \n \n Lee\n S\n \n \n Hong\n N\n \n \n Kim\n KJ\n \n \n Park\n CH\n \n \n Lee\n J\n \n \n Rhee\n Y\n \n \n \n 2021"},{"key":"B27","unstructured":"New anabolic therapies in osteoporosis\n \n \n \n Rubin\n MR\n \n \n Bilezikian\n JP\n \n \n \n 2003"},{"key":"B28","unstructured":"Effect of teriparatide on pregnancy and lactation-associated osteoporosis with multiple vertebral fractures\n \n \n \n Choe\n EY\n \n \n Song\n JE\n \n \n Park\n KH\n \n \n Seok\n H\n \n \n Lee\n EJ\n \n \n Lim\n SK\n \n \n \n 2012"},{"key":"B29","doi-asserted-by":"crossref","unstructured":"Changes in bone mineral density and bone turnover markers during treatment with teriparatide in pregnancy- and lactation-associated osteoporosis\n \n \n \n Hong\n N\n \n \n Kim\n JE\n \n \n Lee\n SJ\n \n \n Kim\n SH\n \n \n Rhee\n Y\n \n \n \n 2018","DOI":"10.1111\/cen.13557"},{"key":"B30","unstructured":"Highlights of prescribing information - teriparatide injection"},{"key":"B31","unstructured":"Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis\n \n \n \n Finkelstein\n JS\n \n \n Wyland\n JJ\n \n \n Lee\n H\n \n \n Neer\n RM\n \n \n \n 2010"},{"key":"B32","unstructured":"Opposite bone remodeling effects of teriparatide and alendronate in increasing bone mass\n \n \n \n McClung\n MR\n \n \n Martin\n JS\n \n \n Miller\n PD\n \n \n Civitelli\n R\n \n \n Bandeira\n F\n \n \n Omizo\n M\n \n \n \n 2005"},{"key":"B33","unstructured":"Bridging the gap: Pregnancy\u2014and lactation\u2014associated osteoporosis\n \n \n \n Carsote\n M\n \n \n Turturea\n MR\n \n \n Valea\n A\n \n \n Buescu\n C\n \n \n Nistor\n C\n \n \n Turturea\n IF\n \n \n \n 2023"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1934166\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:29:34Z","timestamp":1789619374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1934166\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":33,"alternative-id":["10.3389\/fendo.2026.1934166"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1934166","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"article-number":"1934166"}}