ÖZET
Bu derlemenin yazılma amacı, gebelik ve laktasyonla ilişkili osteoporoz (PLO) araştırmalarındaki son gelişmeler hakkında bir güncelleme sağlamak ve spesifik tedaviler için mevcut kanıtları özetlemektir. PLO, gebeliğin üçüncü trimesterinde ve doğum sonrası dönemde doğurganlık çağındaki kadınları etkileyen geçici ve nadir bir osteoporoz şeklidir. PLO’nun patofizyolojisi tam olarak anlaşılamamış olsa da, PLO’nun ilerlemesinde geleneksel risk faktörlerinin yanı sıra gebelik ve laktasyonun rolünü vurgulayan birkaç olgu serisi, olgu çalışması ve daha az sayıda kohort çalışması mevcuttur. 1996-2023 yılları arasında PubMed, Embase, Scopus, Google Scholar, Dünya Sağlık Örgütü bölgesel veri tabanlarından gebelik ve laktasyonla ilişkili osteoporozla ilgili çeşitli olgu çalışmaları, olgu serileri, kohort çalışmaları, meta-analizler ve anlatı incelemelerini içeren yaklaşık 300 araştırma ve inceleme makalesi incelenmiştir. Yaygın klinik belirtiler arasında bel ve kalça ağrısı ve nadiren vertebral kompresyon kırıkları yer almaktadır. Hamilelik ve emzirme döneminde kadınlar mineral homeostazında ve iskelet metabolizmasında geri dönüşümlü değişikliklere maruz kalırlar. Gebelik sırasında artan kalsiyum emilimi ve idrarla atılımı ve laktasyonda renal kalsiyum geri emilimi ile birlikte artan kemik rezorpsiyonu, sırasıyla fetüsün ve yenidoğanın iskelet büyümesini ve gelişimini destekleyen ana maternal metabolik adaptasyonlardır. PLO’nun yönetimi, biyokimyasal kemik döngüsü belirteçleri ve kemik histomorfometrisi kullanılarak doğru tanı ve prognoza bağlıdır. Geleneksel yöntemler arasında kalsiyum ve D vitamini takviyesi, emzirmenin bırakılması, fizyoterapi, destekleyici breysler ve yatak istirahati yer almaktadır. Bisfosfonatlar, denosumab ve teriparatid yaygın olarak reçete edilen ilaçlardır ve bazı yan etkilerinin yanı sıra kemik mineral yoğunluğunun iyileşmesini sağlarlar. Olguların geçici doğası ve az bildirilmesi göz önünde bulundurularak, tedavi önerileri parite, laktasyon süresi, kırık varlığı veya yokluğu, toplumsal statü, yaş, etnik köken ve ırka göre kişiselleştirilmelidir.
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