A 34-year-old woman developed rare bone fractures from breastfeeding. She had to use a walker and sneezing caused the 'worst pain' of her life.

• Ultima Espino, 35, developed symptoms of osteoporosis after giving birth.
• She had multiple unexplained bone fractures and started using a walker.
• She was diagnosed with pregnancy and lactation-associated osteoporosis, a rare form of the disease.

Less than six months after giving birth to her second son, Ultima Espino was using a walker.

Espino, 35, remembers the first jolt of pain in her back three months postpartum, when she lifted her three-year-old son out of the car. She thought she had tweaked it.

"I felt like I pulled a muscle so severely that every single hour of every day, that pain was compounding," Espino told Business Insider.

It wasn't until months later — after cycling through multiple doctors offices — that she learned she actually had multiple bone fractures in her spine, a rare syndrome triggered by breastfeeding.

Espino was confused. She was very active throughout both her pregnancies, attending Orangetheory classes. She worked out all throughout her first pregnancy — her water broke while she was exercising — but she had to stop during her second when she felt some joint pain two months before her due date.

"I just chalked it up to 'most women don't work out that far into pregnancy,'" she said. After giving birth, Espino felt fine until the back incident. Within months, the pain became so severe that she started wearing a back brace recommended by an interventional spine and pain management physician. Eventually, when she was struggling to walk, her husband suggested they buy a walker.

The cause turned out to be osteoporosis, a disease most associated with post-menopausal women.

Excruciating pain with no answers

At first, Espino, who works as a senior director of sports partnerships at Orlando Health, thought she had a common sports and postpartum issue: a weakened core. She booked an appointment with a pelvic floor physical therapist.

By the time she saw the PT, her pain was much more severe. "I couldn't put on pants without crying," she said. The PT reiterated that her pain wasn't related to her core. "They're like, 'You belong somewhere else,'" Espino said. "It's definitely not here."

Her pain accelerated for months, with no clear answers. She couldn't lay her newborn down without first needing to rest her forearms on either side of the bassinet. She also couldn't do it without "wailing in pain."

Putting the car seat in and out of the car was even more challenging. Once, when she was trying to remove the car seat with her baby still in it, she felt the pain again, and the seat started to fall. A dad ran up to catch the car seat in time.

That's when Espino started to realize there were bigger issues besides a pulled muscle or tweaked back. Her husband, concerned about her pain, suggested they get her a walker for the time being. Once she did, it helped her get from one end of the house to the other "without feeling like I was going to break."

The true wake-up call came one morning, when Espino was already feeling a lot of pain. She was helping her older son get dressed for school. Suddenly, she felt a sneeze coming.

"My entire body knew that that was not going to go well," she said.

The pain was "out of the park" the worst she'd felt in her life, more debilitating than long hours in labor. "It felt like my spine was being pulled apart," she said.

An 'aha' diagnosis moment

Espino was rushed to the Orlando Health Jewel Orthopedic Institute and got an MRI. She learned she had four compression fractures in her spine.

She was immediately sent for testing, from calcium analysis to ultrasounds. A DEXA scan, which measures muscle and bone mass, finally confirmed that she had osteoporosis — though it was still unclear how or why.

We spoke to one of Espino's doctors: Dr. Christine Jablonski, who specializes in bone health and orthopedics at Orlando Health. She suspected that Espino, whose mother was also diagnosed with osteoporosis at a young age by Jablonski, might have a rare form of osteoporosis related to lactation. In both pregnancies, Espino had an overproduction of milk, which could lead to calcium loss. When the body can't rebound from overproduction, it can result in osteoporosis.

"It's not very common and I hadn't seen it before, but I suspected this was the cause of Ultima's condition," Jablonski told Business Insider.

Around that time, Jablonski just so happened to attend the annual Interdisciplinary Symposium on Osteoporosis in Washington, DC, when one of the speakers gave a talk on pregnancy and lactation-associated osteoporosis (PLO). After the presentation, she rushed over to the speaker and shared Espino's symptoms. He confirmed that it sounded like PLO.

From there, she was able to piece together what likely happened: Espino was genetically predisposed to develop osteoporosis. Because she had two pregnancies close together — at 30 and 33 — and had an overproduction of milk, it created a "perfect storm" for developing osteoporosis, Espino said.

Parenting while recovering

Espino was instructed to stop breastfeeding her son to curb her calcium loss. Emotionally, it was a hard rule to follow: her first son didn't latch, and she loved the bond she felt breastfeeding her second. She was also discouraged from getting pregnant again, as it could exacerbate her osteoporosis even more.

"We were planning to probably be done with two, but to be told, in the height of pain, that you likely shouldn't carry another baby and to stop breastfeeding, that was super hard," she said.

For the past year, Espino has been receiving bone growth injections and taking calcium supplements. Within the first six months of treatment, her bone density increased by 15% and one of her compression fractures healed. While her pain became less constant, she has no hard timeline for when she'll be pain-free.

Still, she's seen small improvements in her quality of life. She can hold her one-year-old and lower herself on the floor to play with her four-year-old son.

Ultimately, she's glad she sought medical help and wishes more moms would do the same, even if her condition is very rare. "Especially as moms, we really just take it all on and say, 'we know these years are going to be hard,'" she said. "If Mom isn't taking care of herself, no one else can."