A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses

Ritchie, Lorrene D.; Fung, Ellen B.; Halloran, B. P.; Turnlund, Judith R.; Loan, Marta D. Van; Cann, Christopher E.; King, Janet C.

doi:10.1093/ajcn/67.4.693

Cited by 419 publications

(431 citation statements)

References 25 publications

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“…Since our study was focused on recovery one year postpartum, the impact of pregnancy on bone mass was not determined. In adolescent mothers followed up for a year postpartum, BMC and BMD loss and recovery follow a pattern similar to that observed in adult women (1,2,(20)(21)(22)(23)(24)(25) . To our knowledge, there are no papers reporting that BMC in lactating adolescents ,16 years of age is lower than that of 16-17-year-old adolescents due to the fact that the former may not be completely physiologically mature, as described in teenage pregnancies with respect to linear growth (47) .…”

Section: Discussionsupporting

confidence: 67%

Changes in bone mineral density of adolescent mothers during the 12-month postpartum period

Malpeli¹,

Mansur²,

Santiago³

et al. 2009

Public Health Nutr.

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Objective: Bone mineral density (BMD) loss has been described in adult women in the 12-month postpartum period. However, little is known about the precise BMD pattern in adolescent mothers. The present study aimed to evaluate BMD in Argentinean adolescent mothers followed up during the 12-month postpartum period. Design: Analytical, prospective clinical trial. BMD and body composition were determined by dual-energy X-ray absorptiometry; bone mineral content (BMC) and BMD were measured in the lumbar spine (L2-L4), femoral neck (FN), femur trochanter (TR), total hip (TH) and total body. Changes in BMD and BMC were analysed using ANOVA for pairwise comparisons. Other comparisons were performed with the paired-sample t test and Wilcoxon test; Pearson's correlation coefficient was used to analyse the relationship among continuous variables. Setting: La Plata, Argentina. Subjects: Adolescent mothers (n 35; 17 years old or less) were recruited within 15 d after delivery. Studies and follow-up were performed at 15 d and 3, 6 and 12 months postpartum. Results: BMD and BMC losses at 3 and 6 months and recovery at 12 months fitted a quadratic curve (ANOVA) at the three sites studied (FN, TH, TR), in total-body BMD (P 5 0?000) and BMC (P 5 0?038). At hip sites, BMD loss occurred at 3 months (FN, P 5 0?000; TR, P 5 0?000; TH, P 5 0?000) and 6 months (FN, P 5 0?000; TR, P 5 0?000; TH, P 5 0?000) compared with basal values. Percentage BMD loss immediately after delivery up to 6 months was about 5 %. Conclusions: Adolescents showed significant BMD and BMC losses at 6 months postpartum, with an almost total recovery at 12 months in all sites studied.

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Section: Discussionsupporting

confidence: 67%

Changes in bone mineral density of adolescent mothers during the 12-month postpartum period

Malpeli¹,

Mansur²,

Santiago³

et al. 2009

Public Health Nutr.

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“…First, estrogen deficiency associated with lactation, like menopause, increases the rate of bone remodeling. (23) More remodeling events excavate bone upon the surfaces of intracortical canals, endocortical surface and trabeculae. The rapid increase in cortical porosity and decrease in trabecular BV/TV are the net result of many excavated sites that appear at the same time as refilling occurs in the fewer cavities excavated pre-lactation, before remodeling becomes rapid.…”

Section: Discussionmentioning

confidence: 99%

“…To accurately capture changes during exclusive breastfeeding, each woman had the second assessment within 14 days of cessation of exclusive breastfeeding because the shift to intermittent breastfeeding is followed shortly by resumption of menses and possible slowing of remodeling as estrogen levels rise. (23) The third and final assessment occurred after a median total follow-up since delivery of 3.6 years (range 0.9 to 5.4). Total follow-up included a median of total breastfeeding for 13 months (range 3 to 31), exclusive breastfeeding for 5 months, intermittent breastfeeding (2 to 4 times daily combined with other nutrition for 7 months (range 0 to 25), and 2.6 years (range 1 to 4.8) followup after stopping breastfeeding.…”

Section: Methodsmentioning

confidence: 99%

“…(7,17,18) Bone loss during breastfeeding in humans is reported, but whether the microstructural deterioration is reversible after cessation of breastfeeding in human subjects is uncertain. (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) As trabecular bone loss, trabecular thinning, and perforation proceed rapidly after estrogen deficiency, the resulting bone fragility is attributed to deterioration in trabecular bone.…”

Section: Introductionmentioning

confidence: 99%

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Irreversible Deterioration of Cortical and Trabecular Microstructure Associated With Breastfeeding

Bjørnerem

Ghasem‐Zadeh

Wang

et al. 2016

Journal of Bone and Mineral Research

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Estrogen deficiency associated with menopause is accompanied by an increase in the rate of bone remodeling and the appearance of a remodeling imbalance; each of the greater number of remodeling transactions deposits less bone than was resorbed, resulting in microstructural deterioration. The newly deposited bone is also less completely mineralized than the older bone resorbed. We examined whether breastfeeding, an estrogen-deficient state, compromises bone microstructure and matrix mineral density. Distal tibial and distal radial microarchitecture were quantified using high-resolution peripheral quantitative computed tomography in 58 women before, during, and after breastfeeding and in 48 controls during follow-up of 1 to 5 years. Five months of exclusive breastfeeding increased cortical porosity by 0.6% (95% confidence interval [CI] 0.3-0.9), reduced matrix mineralization density by 0.26% (95% CI 0.12-0.41) (both p < 0.01), reduced trabecular number by 0.22 per mm (95% CI 0.15-0.28), and increased trabecular separation by 0.07 mm (95% CI 0.05-0.08) (all p < 0.001). Relative to prebreastfeeding, at a median of 2.6 years (range 1 to 4.8) after cessation of breastfeeding, cortical porosity remained 0.58 SD (95% CI 0.48-0.68) higher, matrix mineralization density remained 1.28 SD (95% CI 1.07-1.49) lower, and trabeculae were 1.33 SD (95% CI 1.15-1.50) fewer and 1.06 SD (95% CI 0.91-1.22) more greatly separated (all p < 0.001). All deficits were greater than in controls. The results were similar at distal radius. Bone microstructure may be irreversibly deteriorated after cessation of breastfeeding at appendicular sites. Studies are needed to establish whether this deterioration compromises bone strength and increases fracture risk later in life.

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“…Independently of lactating practice, P-25OHD is found within reference ranges with the well-known seasonal variations (Cross et al, 1995;Ritchie et al, 1998). The fetus depends on sufficient vitamin D supplementation from the pregnant women.…”

Section: Introductionmentioning

confidence: 87%

Postpartum vitamin D insufficiency and secondary hyperparathyroidism in healthy Danish women

et al. 2006

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Objective: To examine vitamin D status and parathyroid function in normal Danish women postpartum. Design: Three cross-sectional measures during follow-up of 89 women postpartum. Subjects and intervention:We assessed vitamin D status by measuring plasma 25-hydroxyvitamin D (P-25OHD) and the degree of secondary hyperparathyroidism by measuring plasma parathyroid hormone (P-PTH) in 89 Caucasian women at three consecutive visits: (mean (range)) 23 (10-37) days (spring), 117 (95-140) days (late summer) and 274 (254-323) days (winter) postpartum. Results: P-25OHD showed seasonal variations with higher values in late summer than in the other periods (Po0.001). At the first visit, 65% received vitamin D supplements. At the following visits, almost 50% were supplemented. Vitamin D insufficiency (P-25OHDo50 nmol/l) occurred more often during winter (28%) than in spring (14%) (Fisher's exact test, P ¼ 0.02) or late summer (7%) (P ¼ 0.0001). Irrespective of season, vitamin D insufficiency occurred most frequent in women who did not take vitamin D supplements (Fisher's exact test, Po0.02). Frank vitamin D deficiency (P-25OHDo25 nmol/l) was observed during winter in 6%. At all three periods, P-25OHD correlated inversely with P-PTH indicating secondary hyperparathyroidism at deficient vitamin D status. During spring, late summer and winter three, one and four females, respectively, had elevated plasma PTH. Conclusion: Vitamin D insufficiency with secondary hyperparathyroidism is a frequent finding in healthy Danish women postpartum and especially during winter. Vitamin D supplements reduced the risk of vitamin D insufficiency, especially during winter. Our results support the importance of increased alertness regarding information of pregnant and lactating women about vitamin D supplements. Furthermore, it has to be studied whether the present recommendations of an intake of 5-10 mg vitamin D/day are sufficient, especially during winter months.

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A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses

Cited by 419 publications

References 25 publications

Changes in bone mineral density of adolescent mothers during the 12-month postpartum period

Changes in bone mineral density of adolescent mothers during the 12-month postpartum period

Irreversible Deterioration of Cortical and Trabecular Microstructure Associated With Breastfeeding

Postpartum vitamin D insufficiency and secondary hyperparathyroidism in healthy Danish women

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