摘要
妊娠哺乳相关骨质疏松症(pregnancy and lactation associated osteoporosis,PLO)是一种罕见的疾病,主要发生在妊娠晚期和产后早期妇女,常在第一次妊娠时发病,以胸腰椎多发压缩性骨折最常见,主要表现为腰背疼痛、身高变矮、活动受限。其发病机制目前尚不清楚,可能与妊娠、哺乳状态、遗传因素等相关。在怀孕期间,通过肠道钙吸收的加倍以满足胎儿及母体对钙的需求,但如果母亲摄入的钙不足,不能满足母亲和胎儿的综合需求,母亲的骨骼会通过PTHrP(parathyroid hormone-related peptide,PTHrP)刺激骨骼吸收。哺乳期,在高水平PTHrP的主导作用和低雌激素的共同作用下,促进骨吸收动员骨钙入血。目前PLO尚无统一的诊断标准,防治措施尚无定论。现有研究表明大多数PLO患者在断奶后骨量逐渐增加,因此对PLO患者建议停止哺乳并补充充足钙剂及维生素D。有报道双膦酸盐、迪诺赛麦、特立帕肽等抗骨质疏松药物治疗PLO,但其存在或潜在的不良反应,使用受到限制;椎体成形术和后凸成形术等用于治疗产后椎体骨折整体疗效尚不明确,一般不推荐使用。对PLO患者需充分评估患者情况慎重选择治疗方案。
Pregnancy and lactation associated osteoporosis(PLO)is a rare disease,mainly occurring in women at late pregnancy and early postpartum.It always occurs in the first pregnancy.The multiple compression fractures of the thoracolumbar spine are most common,mainly manifested as low back pain,reduced height and limited mobility.Its pathogenesis is still unclear,and may be related to pregnancy,lactation and genetic factors.During pregnancy,the absorption of calcium in the intestine is doubled to meet the needs of fetuses and mothers for calcium.However,if mothers’calcium intake is insufficient to meet the comprehensive needs of the mothers and fetuses,the mothers’bone will stimulate bone absorption through parathyroid hormone-related peptide(PTHrP).During lactation,under the leading role of high PTHrP level and the combined effect of low estrogen,bone absorption is promoted and bone calcium is mobilized into the blood.At present,there is no unified diagnostic standard for PLO,and the prevention and treatment measures are still uncertain.Existing studies have shown that the bone mass of most PLO patients increases gradually after weaning.Therefore,for PLO patients,it is recommended to stop breastfeeding and supplement adequate calcium and vitamin D.Anti-osteoporosis drugs such as bisphosphonate,denosumab and teriparatide have been reported to be used to treat PLO.However,its existing or potential side effects limit the use.The overall efficacy of vertebroplasty and kyphoplasty in the treatment of postpartum vertebral fractures is still not clear,so they are generally not recommended.For PLO patients,their conditions should be fully evaluated and treatment plan should be carefully chosen.
作者
刘洋贝
罗敏
马勋龙
黄昶荃
王覃
卢春燕
陈德才
LIU Yangbei;LUO Min;MA Xunlong;HUANG Changquan;WANG Qin;LU Chunyan;CHEN Decai(Department of Endocrinology and Metabolism,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Geriatrics,Mianyang No.3 People’s Hospital of Sichuan Province,Mianyang 621000,China)
出处
《中国骨质疏松杂志》
CAS
CSCD
北大核心
2020年第3期464-468,共5页
Chinese Journal of Osteoporosis
关键词
骨质疏松
妊娠
哺乳
osteoporosis
pregnancy
lactation
