妊娠期及哺乳期相关骨质疏松症：IAPM、IOF、ECTS、ESCEO、IMS和EMAS的立场声明
Pregnancy- and lactation-associated osteoporosis: A position statement of the IAPM, IOF, ECTS, ESCEO, IMS, and EMAS.
摘要(中文译文)
妊娠哺乳相关骨质疏松症（PLO）是一种以妊娠晚期或产后早期发生脆性骨折（最常见为椎体骨折，常为多发）为特征的综合征。本立场声明基于已发表证据的综述，总结了目前对PLO的认识以及推荐的评估、诊断和治疗流程。由于PLO是一种罕见疾病，对照性临床研究有限。本文对各项研究进行了个体化回顾，重点关注研究设计、样本量、随访、安全性评估以及影响PLO结局的因素。PLO的诊断应包括详细的临床检查、病史及治疗史回顾，以及实验室检查以排除继发性骨质疏松症。影像学技术可用于指导合适的治疗路径，具体取决于患者处于产前还是产后阶段。PLO及骨折的管理包括钙/维生素D摄入/补充、考虑停止哺乳，以及必要时给予镇痛治疗。骨特异性药物的治疗应基于个体化评估，以降低后续骨折风险，需注意其在PLO患者中的使用属于超说明书用药。若使用药物治疗，必须同时采取有效的避孕措施。双膦酸盐可通过胎盘屏障，并可在骨骼中存留数年，因此对未来妊娠的不良影响虽尚未见报道，但不能排除。首选治疗方案为特立帕肽/阿巴洛帕肽或罗莫索单抗。二线治疗为地舒单抗后续双膦酸盐或单用双膦酸盐。本立场声明提出了识别PLO女性的实用方法，并建议制定可能包括药物干预的个体化治疗方案。
Abstract
Pregnancy- and lactation-associated osteoporosis (PLO) is a syndrome characterized by fragility fractures (most commonly vertebral, often multiple) occurring in late pregnancy or the early postpartum period. This position statement summarizes the current knowledge of PLO, and the recommended procedure for assessment, diagnosis and treatment based on a review of published evidence. As PLO is a rare condition, controlled, comparative clinical studies are limited. Individual studies were reviewed, focusing on design, size, follow-up, evaluation of safety, and factors that impact PLO outcomes. Diagnosis of PLO should include a detailed clinical examination, a review of medical and treatment history, and laboratory tests to rule out secondary osteoporosis. Imaging techniques can be used to inform the appropriate treatment pathway, which will depend on whether the patient is antepartum or postpartum. Management of PLO and fractures includes calcium/vitamin D intake/supplementation, considering stopping breastfeeding, and analgesia, if necessary. Treatment with bone-specific agents should be evaluated on an individual basis to reduce subsequent fracture risk, noting that their use in PLO patients is off label. If pharmacological treatments are used, they must be given alongside effective contraceptive measures. Bisphosphonates can pass the placental barrier and are detectable in bone for years, so adverse effects on future pregnancies, although not yet reported, cannot be excluded. Preferred treatment options are teriparatide/abaloparatide or romosozumab. Second-choice treatments are denosumab followed by bisphosphonates or bisphosphonates alone. This position statement includes a pragmatic approach for identifying women with PLO and suggests developing an individualized treatment plan that might include pharmaceutical intervention.
如何引用
AMA
Peyman Hadji, Apostolos Athanasiadis, Maria-Luisa Brandi, Marlene Chakhtoura, Manju Chandran, Frank Chervenak, et al. Pregnancy- and lactation-associated osteoporosis: A position statement of the IAPM, IOF, ECTS, ESCEO, IMS, and EMAS.. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2026; doi:10.1002/ijgo.71203.
APA
Peyman Hadji, Apostolos Athanasiadis, Maria-Luisa Brandi, Marlene Chakhtoura, Manju Chandran, Frank Chervenak, et al (2026). Pregnancy- and lactation-associated osteoporosis: A position statement of the IAPM, IOF, ECTS, ESCEO, IMS, and EMAS.. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. https://doi.org/10.1002/ijgo.71203
GB/T 7714
Peyman Hadji, Apostolos Athanasiadis, Maria-Luisa Brandi, Marlene Chakhtoura, Manju Chandran, Frank Chervenak, et al. Pregnancy- and lactation-associated osteoporosis: A position statement of the IAPM, IOF, ECTS, ESCEO, IMS, and EMAS.[J]. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2026 doi:10.1002/ijgo.71203.
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