The effect of pregnancy on pre-existing osteopenia: a case report.

A 34-year-old Greek Cypriot lady (Mrs. AMC) P(2+0) booked at 10 weeks gestation with spontaneously conceived dizygotic twins. Her two previous uncomplicated pregnancies resulted in normal vaginal deliveries of male infants weighing 3.2 and 3.4 kg, respectively. Immediately following her second delivery, she underwent a manual removal of placenta (MRP) under general anaesthesia and sustained a fracture of the triquetral bone of her left wrist while being lifted off the operating table. Although she had complained of pain and restricted movement in her left hand after the MRP, the fracture remained undiagnosed for several weeks until an X-ray of her left wrist showed signs of delayed fracture healing of the triquetral bone. The pathological fracture was suggestive of osteoporosis during pregnancy but this was not investigated further at this stage. In 2004, she was referred to an orthopaedic surgeon with concern over a height loss of 3 cm in the preceding 6 months, as well as with generalised bony tenderness over her hips and lower back. Dual Energy X ray Absorptiometry (DEXA) to measure bone mineral density (BMD) revealed a T score of -1.6 SD (which is the WHO definition of osteopenia) in her right hip, which subsequently deteriorated to -1.8 SD (Table 1)