Top

Osteoporosis International

Published in:

01-06-2012 | Original Article

Forearm bone mineral density changes during postpartum and the effects of breastfeeding, amenorrhea, body mass index and contraceptive use

Authors: M. L. Costa, F. G. Krupa, P. M. Rehder, M. H. Sousa, L. Costa-Paiva, J. G. Cecatti

Published in: Osteoporosis International | Issue 6/2012

Abstract

Summary

Prospective cohort study performed to evaluate bone mineral density (BMD) changes up to 12 months postpartum of healthy women and its association with breastfeeding, contraceptive methods, amenorrhea, and body mass index (BMI). There is a trend in bone loss during the first 6 months with posterior recovery, with evidence of a protective effect of hormonal contraception.

Introduction

This study was conducted to evaluate bone mineral density (BMD) changes during postpartum period among healthy women and its association with breastfeeding, use of contraceptive methods, amenorrhea and body mass index (BMI).

Methods

A prospective cohort study including 100 healthy women. Distal BMD was measured 7–10 days, 3, 6, and 12 months postpartum at the nondominant forearm using dual-energy X-ray absorptiometry. Data about breastfeeding duration, amenorrhea, contraceptive use and BMI were collected.

Results

Seventy-eight women had a complete set of BMD measurements. The mean duration of exclusive breastfeeding was 125.9 (±66.6) days, with a median total lactation period of 263.5 days. The mean duration of amenorrhea was 164.2 (±119.2) days. BMD measurements showed a significant decrease in the distal radius, however with no significance in the ultradistal radius. When considering only the nonhormonal contraceptive users, the difference at 12 months was significant. Multivariate analysis of variance showed that both BMI and contraceptive use were significantly correlated with BMD. Multiple linear regression analysis showed significant correlation of distal radius with baseline BMD at the same site, pregestational BMI, age, years of schooling and difference in BMI. For ultradistal radius, there was a significant direct correlation with its baseline BMD and pregestational BMI.

Conclusions

There was a trend in bone loss during the first 6 months postpartum with posterior recovery. Also, hormonal contraceptive methods provided protection of bone loss. However, the long duration of breastfeeding and the follow-up were not sufficient to draw definitive conclusions on postweaning BMD conditions.

WHO—World Health Organization (2000). Prevention and management of osteoporosis: report of a WHO Scientific Group. Report series 921. Geneva, WHO, 194p. Available at http://whqlibdoc.who.int/trs/who_trs_921.pdf Access on 12/05/2011

Lenora J, Lekamwasam S, Karlsson MK (2009) Effects of multiparity and prolonged breast-feeding on maternal bone mineral density: a community-based cross-sectional study. BMC Womens Health 1:19CrossRef

Ensom MH, Liu PY, Stephenson MD (2002) Effect of pregnancy on bone mineral density in healthy women. Obstet Gynecol Surv 57(2):99–111PubMedCrossRef

Karlsson MK, Ahlborg HG, Karlsson C (2005) Female reproductive history and the skeleton—a review. BJOG 112(7):851–856PubMedCrossRef

Laskey MA, Prentice A (1997) Effect of pregnancy on recovery of lactational bone loss. Lancet 349(9064):1518–1519PubMedCrossRef

Holmberg-Marttila D, Sievänen H, Laippala P, Tuimala R (2000) Factors underlying changes in bone mineral during postpartum amenorrhea and lactation. Osteoporos Int 11(7):570–576PubMedCrossRef

Kish L (1965). Survey sampling. New York: Wiley, 1st ed

Eis SR, Lewiecki EM (2006) Peripheral bone densitometry: Clinical applications. Arq Bras Endocrinol Metabol 50(4):596–602PubMedCrossRef

ISCD—The International Society for Clinical Densitometry (2007). 2007 ISCD official positions. Available at http://www.iscd.org/visitors/positions/OfficialPositionsText.cfm Access on 12/05/2011

10.

Drinkwater B, Chesnut CH 3rd (1991) Bone density changes during pregnancy and lactation in active women: a longitudinal study. Bone Miner 14(2):153–160PubMedCrossRef

11.

Sowers M, Corton G, Shapiro B, Jannausch ML, Crutchfield M, Smith ML, Randolph JF, Hollis B (1993) Changes in bone density with lactation. JAMA 269(24):33130–33135CrossRef

12.

Affinito P, Tommaselli GA, di Carlo C, Guida F, Nappi C (1996) Changes in bone mineral density and calcium metabolism in breastfeeding women: a one year follow-up study. J Clin Endocrinol Metab 81(6):2314–2318PubMedCrossRef

13.

Laskey MA, Prentice A (1999) Bone mineral changes during and after lactation. Obstet Gynecol 94(4):608–615PubMedCrossRef

14.

More C, Bettembuk P, Bhattoa HP, Balogh A (2001) The effects of pregnancy and lactation on bone mineral density. Osteoporos Int 12(9):732–737PubMedCrossRef

15.

Sena MCF, Silva EF, Pereira MG (2007) Trends of breastfeeding in Brazil during the last quarter of XXth century. Rev Bras Epidemiol 10(4):499–505CrossRef

16.

IBGE—Instituto Brasileiro de Geografia e Estatística (2010). [Study on family budgets 2008–2009. Antropometrical and nutritional status of children, adolescents and adults in Brazil]. Rio de Janeiro: IBGE, 130p. Available at http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/pof/2008_2009_encaa/pof_20082009_encaa.pdf Access on 12/05/2011

17.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19(4):385–397PubMedCrossRef

18.

De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ 3rd, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16(11):1330–1338PubMedCrossRef

Title: Forearm bone mineral density changes during postpartum and the effects of breastfeeding, amenorrhea, body mass index and contraceptive use
Authors: M. L. Costa
F. G. Krupa
P. M. Rehder
M. H. Sousa
L. Costa-Paiva
J. G. Cecatti
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 6/2012
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-011-1767-y

At a glance: The STEP trials

Springer Medicine

Forearm bone mineral density changes during postpartum and the effects of breastfeeding, amenorrhea, body mass index and contraceptive use

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2012

The influence of participation in Better Bones and Balance™ on skeletal health: evaluation of a community-based exercise program to reduce fall and fracture risk

Osteoblastogenesis regulation signals in bone remodeling

Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial

Determinants of undercarboxylated and carboxylated osteocalcin concentrations in type 1 diabetes

Bisphosphonates for periprosthetic bone loss after joint arthroplasty: a meta-analysis of 14 randomized controlled trials

Excess mortality after hip fracture among elderly women in Norway