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Bone turnover and density in healthy women during breastfeeding and after weaning

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Abstract

To investigate the changes in maternal bone density and turnover associated with lactation we ran a longitudinal study in fully breastfeeding women (age 26.3±4.1 years, mean±SD) at the first (stage I, n=30) and sixth (stage II, n=25) months postpartum and 6 months after weaning (stage III, n=20), and in a contemporary control group of non-nursing women. At each time point bone density, serum calcium, phosphorus, alkaline phosphatases, parathyroid hormone (PTH), osteocalcin, follicle stimulating hormone (FSH), estradiol (E2), prolactin (PRL) urinary hydroxyproline and creatinine (OH-P/Cr) were measured in both groups. The daily calcium intake of nursing women (1479±590 mg/day at stage I) was higher than in non-nursing women (536±231 mg/day at stage I). Biochemical markers of bone turnover were higher (p<0.05) in nursing than in non-nursing women at stages I and II, while in stage III only OH-P/Cr was elevated. The lumbar spine (L2–4) bone mineral density was similar in the two groups at the beginning of the study (1.148 ±0.111 g/cm2 in nursing women vs 1.211±0.102 g/cm2 in non-nursing women; p=0.06), but it was lower in nursing women at stage II (1.144±0. 110g/cm2vs 1.216±0.095 g/cm2 respectively; p<0.05). Right femoral neck bone density decreased by 3% between stages I and II in nursing women but did not differ from values in non-nursing women (0.947±0.110 vs 0.973±0.108 in stage I and 0.918±0.114 vs 0.975±0.098 in stage II respectively; ps<0.05, ANOVA). After weaning, lumbar spine and femoral neck bone density increased by 6% and 8% respectively (p<0.05, ANOVA). No correlation was found between changes in bone turnover markers or bone density and parity, frequency and duration of nursing episodes, body weight, body mass index, and plasma PRL, E2 and PTH levels. We conclude that in nursing women with a daily calcium intake at the recommended dietary allowance (>1200 mg/day), full breastfeeding extending over 6 months is characterized by increased maternal bone turnover and a transient bone loss which normalizes after weaning.

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References

  1. Walker ARP, Arvidsson UB, Draper WL. Breast feeding and diet [letter]. Lancet 1952;1:317.

    Google Scholar 

  2. McNeilley AS. Breastfeeding and fertility. In: Gray R, Leridon H, Spira A, editors. Biomedical and demographic determinants of reproduction, 1st ed. New York: Oxford University Press, 1993:391–412.

    Google Scholar 

  3. Battin DA, Marrs RP, Fleiss PM, Mishell DR Jr. Effect of suckling on serum prolactin, luteinizing hormone, follicle-stimulating hormone, and estradiol during prolonged lactation. Obstet Gynecol 1985;65:785–8.

    Google Scholar 

  4. Díaz S, Serón-Ferré M, Cárdenas H, Schiappacasse V, Brandeis A, Croxatto H. Orcadian variation of basal plasma prolactin, prolactin response to suckling, and length of amenorrhea in nursing women. J Clin Endocrinol Metab 1989;68:946–55.

    Google Scholar 

  5. Albright F, Smith PH, Richardson AM. Postmenopausal osteoporosis. JAMA 1941;116:2465–74.

    Google Scholar 

  6. Biller BMK, Baum HBA, Rosenthal DI, Saxe VC, Charpie PM, Klibanski A. Progressive trabecular osteopenia in women with hyperprolactinemic amenorhea. J Clin Endocrinol Metab 1992;75:692–7.

    Google Scholar 

  7. Chesney RW, Specker BL, Mimouni F, McKay CP. Mineral metabolism during pregnancy and lactation. In: Coe FL, Favus MJ, editors. Disorders of bone and mineral metabolism, 1st ed. New York: Raven Press, 1992: 383–92.

    Google Scholar 

  8. Chan GM, Slater P, Ronald N, et al. Bone mineral status in lactating mothers of different ages. Am J Obstet Gynecol 1982;144:438–41.

    Google Scholar 

  9. Wardlaw GM, Pike AM. The effect of lactation on peak adult shaft and ultra-distal forearm bone mass in women. Am J Clin Nutr 1986;44:283–6.

    Google Scholar 

  10. Chan GM, McMurry M, Westover K, Engelbert-Fenton K, Thomas MR. Effects of increased dietary intake upon the calcium and bone mineral status of lactating adolescent and adult women. Am J Clin Nutr 1987;46:319–23.

    Google Scholar 

  11. Hayslip CC, Klein TA, Wray L, Duncan W. The effects of lactation on bone mineral content in healthy postpartum women. Obstet Gynecol 1989;73:588–92.

    Google Scholar 

  12. Kent GN, Price RI, Gutteridge DH, et al. Human lactation: forearm trabecular bone loss, increased bone turnover, and renal conservation of calcium and inorganic phosphate with recovery of bone mass following weaning. J Bone Miner Res 1990;5:361–9.

    Google Scholar 

  13. Sowers MF, Corton G, Shapiro B, et al. Changes in bone density with lactation. JAMA 1993;269:3130–5.

    Google Scholar 

  14. Kent GN, Price RI, Gutteridge DH, et al. Effects of pregnancy and lactation on maternal bone mass and calcium metabolism. Osteoporosis Int 1993;3 (Suppl 1): 44–7.

    Google Scholar 

  15. Sowers MF, Wallace RB, Lemke JH. Correlates of forearm bone mass among women during maximal bone mineralization. Prev Med 1985;14:585–96.

    Google Scholar 

  16. Alderman BW, Weiss NS, Dailing JR, Ure CL, Ballard JH. Reproductive history and postmenopausal risk of hip and forearm fracture. Am J Epidemiol 1986;124:262–7.

    Google Scholar 

  17. Byrne J, Thomas MR, Chan GR. Calcium intake and bone density of lactating women in their late childbearing years. J Am Diet Assoc 1988;87:883–7.

    Google Scholar 

  18. Melton LJ, Bryant SC, Wahner HW, et al. Influence of breastfeeding and others reproductive factors on bone mass later in life. Osteoporosis Int 1993;3:76–83.

    Google Scholar 

  19. Aloia JF, Vaswani AN, Yeh JK, Ross P, Ellis K, Cohn SH. Determinants of bone mass in postmenopausal women. Arch Intern Med 1983;143:1700–4.

    Google Scholar 

  20. Specker BL, Tsang RC, Ho ML. Changes in calcium homeostasis over the first year postpartum: effect of lactation and weaning. Obstet Gynecol 1991;78:56–62.

    Google Scholar 

  21. Schmidt-Hebbel H, Pennacchiotti I, Masson L, et al. Tabla de composicion química de alimentos chilenos, 8th ed. Santiago: Imprecar, 1992: 10–28.

    Google Scholar 

  22. Nelson WE, editor. Textbook of pediatrics, 8th ed. Philadelphia: Saunders, 1964;42.

    Google Scholar 

  23. López JM, González G, Campino C, Salvatierra A, Croxatto H. Serum osteocalcin in normal menstrual cycle. Medicina (B Aires) 1991;52:37–40.

    Google Scholar 

  24. Campino C, Bruggiendeck B, Pumarino H, Rojas A, Ferreiro F. Desarrollo de un radioinmunoanálisis (RIA), para fracción media de hormona paratiroídea (m-PTH): comparaci ón con dos kits comerciales para carboxilo terminal. Rev Med Chile 1987;115:763–7.

    Google Scholar 

  25. WHO. Special programme of research development and research training in human reproduction. Programme for the provision of matched assay reagents for the RIA of hormones in reproductive physiology. Method manual, 11th ed. Geneva: WHO, 1987.

    Google Scholar 

  26. Firschein HE, Shill JP. The determination of total hydroxyproline in urine and bone extracts. Anal Biochem 1966;14:296–304.

    Google Scholar 

  27. Riggs BL, Peck WA, Bell NH. Prevention and management of osteoporosis. In: Physician's resources manual on osteoporosis, 2nd ed. New York: Current Medical Directions, 1991:19.

    Google Scholar 

  28. Sowers M, Eyre D, Hollis BW, Randolph JF, Shapiro B, Jannausch ML, Crutchfield M. Biochemical markers of bone turnover in lactating and nonlactating postpartum women. J Clin Endocrinol Metab 1995;80:2210–6.

    Google Scholar 

  29. Naylor A, Newman V. Changes in bone density with lactation [letter] JAMA 1993;270:2300.

    Google Scholar 

  30. Zinaman MJ, Hickey M, Tomai TP, Alberton BD, Simon JA. Calcium metabolism in postpartum lactation: the effect of estrogen status. Fertil Steril 1990;54:465–9.

    Google Scholar 

  31. Riggs BL, Melton LJ. Involutional osteoporosis. N Engl J Med 1986;314:1676–86.

    Google Scholar 

  32. Strewler GJ, Nissenson RA. Parathyroid hormone-related protein. In: Favus MJ, Christakos S, Kleerekoper M, et al., editors. Primer on the metabolic bone diseases and disorders of mineral metabolism, 2nd ed. New York: Raven Press, 1993;61–3.

    Google Scholar 

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Authors and Affiliations

  1. Instituto Chileno de Medicina Reproductiva (ICMER), Chile

    V. Reyes & S. Díaz

  2. Departmento de Endocrinología, Metabolismo y Nutritión, Escuela de Medicina, P. Universidad Católica de Chile, Casilla 114-D, Santiago, Chile

    J. M. López, G. González & C. Campino

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  1. J. M. López
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  2. G. González
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  3. V. Reyes
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  4. C. Campino
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  5. S. Díaz
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López, J.M., González, G., Reyes, V. et al. Bone turnover and density in healthy women during breastfeeding and after weaning. Osteoporosis Int 6, 153–159 (1996). https://doi.org/10.1007/BF01623940

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  • DOI: https://doi.org/10.1007/BF01623940

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