Rare form of osteoporosis around pregnancy gets spotlight at columbia – columbia university medical center la gas


Bone density generally improves as part of the natural recovery after pregnancy. If a woman is breastfeeding, this recovery may start at around six months after delivery, when the baby begins to eat solid food and milk production declines. By the time a baby turns 1, bone density in the spine often returns to normal.

For women with PLO, doctors may also recommend medications that stimulate bone formation after the baby has been weaned. Because this condition is so rare, the efficacy of these treatments has yet to be established. Other treatments may be needed to improve mobility and manage pain.

I’m an endocrinologist with a strong interest in women’s health. For over 15 years, I’ve been collaborating with Dr. Elizabeth Shane at Columbia to investigate pathophysiology and treatment of premenopausal osteoporosis. Having a better understanding of PLO—and determining how it is different from other forms of premenopausal osteoporosis—will allow us to develop more targeted treatments. It may also help us improve the way we treat younger women with osteoporosis in general, even when the disease isn’t associated with pregnancy.

We currently understand so little about PLO, so we’re trying to recruit at least 50 women with the disease. That will enable us to characterize the specific bone structure and metabolism defects associated with PLO and begin to identify risk factors. We also hope to follow women for a period of time to learn how the disease progresses and estimate prognosis, especially in terms of future fracture risk.

Participants will undergo a wide range of tests. We’re using 3-D CT scans to perform detailed bone structural analyses of the arm, leg, spine, and hip. Bone biopsies will allow us to analyze the structure of the bone tissue and study the dynamics of bone formation in individual patients. We’re also using high-resolution 3-D imaging of the biopsy samples to look at osteocytes—special cells involved in bone regulation—for the first time in this population.

Additionally, we’re hoping to find biochemical and hormonal biomarkers that may predict disease severity. And we’re working with Columbia’s Institute for Genomic Medicine to search patients’ DNA to identify genes—either variants of genes that are associated with bone fragility or new genes—that may lead to PLO.

The data and samples that we’re gathering in our current study will enable us to design future studies to examine different treatment approaches. For instance, there is some preliminary evidence that women with PLO have low bone formation, suggesting that their bone-forming cells don’t work properly. Looking at these cells from individual patients may help us develop more targeted therapies and better treatment protocols.

The women who are enrolled in this study are also part of a new interdisciplinary program at Columbia University Irving Medical Center that gives patients access to a variety of specialists that may be involved in their care—including endocrinologists, rehabilitation medicine specialists, and genetics experts. We hope to provide comprehensive care from medical specialists who are familiar with this very rare disorder.

Adi Cohen, MD, MHS, is an associate professor of medicine in the Division of Endocrinology at Columbia University Vagelos College of Physicians and Surgeons. Her study has been funded by an R01 grant from the U.S. FDA Office of Orphan Products Development/Orphan Products Natural History Grants Program.