Parity and risk of hip fracture in postmenopausal women

Kauppi, Maarit; Heliövaara, Markku; Impivaara, Olli; Knekt, Paul; Jula, Antti

doi:10.1007/s00198-010-1392-1

Cited by 27 publications

(34 citation statements)

References 47 publications

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“…This has been examined through numerous epidemiological studies that have ascertained whether parity confers any risk of lower BMD, an osteoporotic level of BMD, or fragility fractures. The majority of such studies have found either a neutral effect of parity (16, (384,397,421,460,625,689,869,997). One of the studies reporting a protective effect of parity was particularly strong because it involved 1,852 twins and their female relatives, including 83 identical twins who were discordant for ever being pregnant (700).…”

Section: Human Datamentioning

confidence: 99%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

338

524

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During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ϳ30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

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Section: Human Datamentioning

confidence: 99%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

338

524

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“…However, the rapid loss in bone mineral density (BMD) during lactation, which may attain 5-10% in 2-6 months, restores along the 6-12 months after weaning through still unclear mechanisms (54). This fast recovery is reflected in epidemiological studies, which do not find an association between the number of pregnancies or the duration of lactation and the future diagnoses of either osteoporosis (55,56) or fragility fracture (57).…”

Section: The Status Of the Skeleton In Pregnancymentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

Sanz-Salvador

Garcı́a-Pérez

Tarı́n

et al. 2015

European Journal of Endocrinology

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Changes in bone density and bone markers suggest that pregnancy is associated with deterioration of bone mass in the mother. The metabolism of calcium resets to allow for the needs imposed by the building of the fetal skeleton. The fetus contributes to the process through the output of regulators from the placenta. Understanding of the whole process is limited, but some changes are unambiguous. There is an increase in the circulating levels of vitamin D, but its functional impact is unclear. Fetal parathyroid hormone (PTH) and PTH-related peptide (PTHrp) play an indirect role through support of a calcium gradient that creates hypercalcemia in the fetus. Placental GH, which increases up to the end of pregnancy, may exert some anabolic effects, either directly or through the regulation of the IGF1 production. Other key regulators of bone metabolism, such as estrogens or prolactin, are elevated during pregnancy, but their role is uncertain. An increase in the ratio of receptor activator of nuclear factor kappa B ligand (RANKL) to osteoprotegerin (OPG) acts as an additional pro-resorbing factor in bone. The increase in bone resorption may lead to osteoporosis and fragility fracture, which have been diagnosed, although rarely. However, the condition is transitory as long-term studies do not link the number of pregnancies with osteoporosis. Prevention is limited by the lack of identifiable risk factors. When fractures are diagnosed, rest, analgesics, or, when indicated, orthopedic intervention have demonstrated efficacy. Systemic treatment with anti-osteoporotic drugs is effective, but the potential harm to the fetus imposes caution in their use.

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“…Nulliparity has been reported to be a risk factor for HF [7,[11][12][13][14][15]. Some studies have shown evidence for decreasing risk of HF associated with increased parity [11,16].…”

Section: Introductionmentioning

confidence: 97%

Parity and osteoporotic fracture risk in postmenopausal women: a dose-response meta-analysis of prospective studies

et al. 2015

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Parity and risk of hip fracture in postmenopausal women

Abstract: Parity, three or more births in particular, predicts a lowered risk of hip fracture in the long run.

Cited by 27 publications

References 47 publications

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

Parity and osteoporotic fracture risk in postmenopausal women: a dose-response meta-analysis of prospective studies

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