Bone mineral changes during and after lactation

Abstract

Objective: To assess bone mineral changes during and after lactation.

Methods: Fifty-nine breast-feeding women, 11 formula-feeding women, and 22 nonpregnant, nonlactating women had dual-energy x-ray absorptiometry measurements of the whole body, spine, hip, and forearm at 0.5 (baseline), 3, 6, and 12 months postpartum, with an additional measurement at 3 months after lactation for women who had breast-fed for more than 9 months.

Results: Lactation was associated with decreases in bone mineral at the whole body, spine, femoral neck, total hip, and radial wrist, which reversed as lactation declined and menstruation resumed. These changes were not seen in formula-feeding women. The magnitude and duration of the response were greater for women who breast-fed for a longer time. After lactation had stopped for at least 3 months, bone mineral, adjusted for bone area, had increased significantly above baseline at the whole body (+1.44%; 95% confidence interval [CI] +0.97%, +1.91%; P < .001), spine (+2.66%; 95% CI +1.60%, +3.72%; P < .001), and greater trochanter (+3.55%; 95% CI +2.53%, +4.57%; P < .001), was not different at the total hip and radial shaft, but was lower at the femoral neck (-2.07%; 95% CI -3.21%, -0.93%; P < .001) and radial wrist (-1.23%; 95% CI -1.99%, -0.47%; P < .01). Changes after lactation were largely independent of the duration of lactation or amenorrhea, and similar effects were observed in formula-feeding women.

Conclusion: Lactation was associated with temporary decreases in bone mineral. After lactation, there were significant residual effects on bone mineral that were unrelated to the duration of lactation and may be related to having been pregnant. The long-term effect of lactation on the femoral neck requires further investigation.