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Yamada S, Hayashi N, Toi N, Miyaoka D, Hashimoto M. Second Child After Pregnancy and Lactation-Related Osteoporosis (PLO) Treated With Teriparatide: A Case Report. Cureus 2024; 16:e64900. [PMID: 39156353 PMCID: PMC11330588 DOI: 10.7759/cureus.64900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
Pregnancy and lactation-associated osteoporosis (PLO) is one of the rarest and most serious primary osteoporotic conditions that develops during the third trimester of gestation and/or early postpartum period. A history of PLO often causes individuals to hesitate when considering an additional child due to anxiety about recurrence risk. Reported here are details of a 29-year-old patient with PLO given aggressive treatment for osteoporosis with teriparatide who subsequently gave birth to a healthy child at age 33 without PLO recurrence. Further case studies are needed to examine the efficacy and safety of PLO treatment and to provide beneficial results for those who wish to have another pregnancy.
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Affiliation(s)
- Shinsuke Yamada
- Clinical Immunology, Osaka Metropolitan University of Medicine, Osaka, JPN
| | | | - Norikazu Toi
- Metabolism, Endocrinology, and Molecular Medicine, Osaka Metropolitan University of Medicine, Osaka, JPN
| | - Daichi Miyaoka
- Immunology and Genomics, Osaka Metropolitan University of Medicine, Osaka, JPN
| | - Motomu Hashimoto
- Clinical Immunology, Osaka Metropolitan University of Medicine, Osaka, JPN
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Oboh I, Coleman C, Cremona A. The influence of lactation and its duration on bone mineral density in pregnancy and postpartum: A systematic review with meta-analysis. Clin Nutr ESPEN 2021; 46:121-132. [PMID: 34857185 DOI: 10.1016/j.clnesp.2021.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is a plethora of research on the association of parity and duration of lactation with bone mineral density (BMD) during and after pregnancy. However, there are no consensus conclusions on the impact of the duration of lactation on BMD. AIMS The aim of this study was to examine the effect of pregnancy, and the duration of lactation on BMD during pregnancy, postpartum phase and 12 months post-delivery. METHODS The search terms 'parity' 'lactation' 'BMD' were searched for using PubMed, CINAHL, SCOPUS and EMBASE databases in English language. Two independent reviewers assessed the quality of the included studies using Critical Appraisal Skills Program (CASP) appraisal tool and extracted data on BMD (g/cm2) in Excel. A meta-analysis was conducted with a random effect model using Cochrane Review Manager (Rev 5.4) to analyse the outcome. Heterogeneity was assessed with Chi Squared and I2 test. The duration of lactation was grouped into short lactation duration (SLD), ≤4 months and longer lactation duration (LLD) > 6 months. RESULTS Twenty-one studies were included in this review with four studies included in the meta-analysis. BMD reduced during pregnancy and lactation. Recovery and net gains in BMD followed weaning. However, at 12 months postpartum, women in the LLD group had significant losses at the lumbar spine while those in the SLD recovered BMD. Between the SLD and LLD groups, the change in BMD was not significant 0.48 g/cm2 (95% CI -0.14, 1.10, p = 0.13). BMD losses were greater in primiparous women than multiparous women. CONCLUSION Women who breastfed for >6 months had significantly reduced BMD. However, compared to women that breastfed for a ≤4 months there was no significant change in BMD. Further investigation is needed to clarify the association between lactation and BMD in a postpartum population in those women extending breastfeeding beyond one year.
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Affiliation(s)
- Isabella Oboh
- University Hospital Limerick (UHL), Limerick, Ireland
| | - Cynthia Coleman
- College of Medicine, Nursing and Health Science, School of Medicine, Regenerative Medicine Institute (REMEDI), National University of Ireland Galway (NUI Galway), Galway, Ireland
| | - Alexandra Cremona
- School of Allied Health, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Irish Nutrition and Dietetics Institute, Dublin, Ireland.
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Akil S, Al-Mohammed H, Al-Batati N, Tirsen M, Al-Otaibi A, AlZahrani A, Bakhder D, AlSubaie R, AbuAlsaud S. Quantitative ultrasound assessment of the effect of parity on bone mineral density in females. BMC WOMENS HEALTH 2021; 21:380. [PMID: 34717605 PMCID: PMC8557593 DOI: 10.1186/s12905-021-01516-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
Background The effect of pregnancy and breastfeeding on a female’s bone mineral density (BMD) is controversial. This prospective study aims to investigate the effect of parity on BMD among pre-menopausal multiparous females using quantitative ultrasound as a screening method and females with no pregnancies (nulliparous) as a control group. Methods A portable ultrasound-based bone densitometer (DMS PEGASUS SMART, Mauguio, France) was used to indirectly assess the BMD in 51 multiparous (29–45 years) and 51 nulliparous Arabic females (18–35 years) by quantifying the broadband ultrasound attenuation (BUA) from their right calcaneus bone. BUA > 70 db/mhz = normal, BUA 65–69.9 db/mhz = below average, BUA 55–64.9 db/mhz = osteopenia and BUA < 55 db/mhz = osteoporosis. Results There was a significant difference in mean BUA between multiparous and nulliparous females (74.1 db/mhz vs. 69.3 db/mhz, p = 0.006). The prevalence of normal BMD was significantly higher in the nulliparous group than in the multiparous group (70.6% vs. 47.1%, p = 0.02). Osteoporosis was found in the multiparous group only (3/51). Among the multiparous females who breastfed (43/51), a total of 51.2% (22/43) had normal BMD, 25.6% (11/43) had BMD below average, 18.6% (8/43) had osteopenia and 4.7% (2/43) had osteoporosis. No significant differences in mean BUA (p = 0.2) were found between the group of females who breastfed for one year (13/43; BUA: 70.5 ± 9.4), the group of females who breastfed for 6–11 months (8/43; BUA: 70.6 ± 10.0) and those who breastfed for less than six months (22/43; BUA: 71.6 ± 9.4). A binary logistic regression model built for predicting BMD normality showed significance for the variable parity (p = 0.03), while the effect of the possible confounding variables BMI and age on BMD normality was found to be non- significant (p = 0.1 and p = 0.6, respectively). Conclusion Parity affects the BMD, as assessed by a portable ultrasound-based bone densitometer, of young and middle-aged females as compared to the BMD of nulliparous females. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01516-w.
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Affiliation(s)
- Shahnaz Akil
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. .,Department of Laboratory Medicine, Clinical Physiology, Karolinska Institutet, Huddinge, Sweden. .,Department of Clinical Physiology, Karolinska University Hospital, 141 86, Stockholm, Sweden.
| | - Huda Al-Mohammed
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Norah Al-Batati
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Maissa Tirsen
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ahad Al-Otaibi
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Aram AlZahrani
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Deena Bakhder
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ruba AlSubaie
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Samar AbuAlsaud
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Song SY, Kim Y, Park H, Kim YJ, Kang W, Kim EY. Effect of parity on bone mineral density: A systematic review and meta-analysis. Bone 2017; 101:70-76. [PMID: 28450215 DOI: 10.1016/j.bone.2017.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/13/2017] [Accepted: 04/24/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Parity has been suggested as a possible factor affecting bone health in women. However, study results on its association with bone mineral density are conflicting. METHODS PubMed, EMBASE, the Cochrane Library, and Korean online databases were searched using the terms "parity" and "bone mineral density", in May 2016. Two independent reviewers extracted the mean and standard deviation of bone mineral density measurements of the femoral neck, spine, and total hip in nulliparous and parous healthy women. RESULTS Among the initial 10,146 studies, 10 articles comprising 24,771 women met the inclusion criteria. The overall effect of parity on bone mineral density was positive (mean difference=5.97mg/cm2; 95% CI 2.37 to 9.57; P=0.001). The effect appears site-specific as parity was not significantly associated with the bone mineral density of the femoral neck (P=0.09) and lumbar spine (P=0.17), but parous women had significantly higher bone mineral density of the total hip compared to nulliparous women (mean difference=5.98mg/cm2; 95% CI 1.72 to 10.24; P=0.006). No obvious heterogeneity existed among the included studies (femoral neck I2=0%; spine I2=31%; total hip I2=0%). CONCLUSION Parity has a positive effect on bone in healthy, community-dwelling women and its effect appears site-specific.
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Affiliation(s)
- Seung Yeon Song
- Evidence Based Research Lab. Department of Health, Social and Clinical Pharmacy, Chung-Ang University, College of Pharmacy, South Korea
| | - Yejee Kim
- Evidence Based Research Lab. Department of Health, Social and Clinical Pharmacy, Chung-Ang University, College of Pharmacy, South Korea
| | - Hyunmin Park
- Evidence Based Research Lab. Department of Health, Social and Clinical Pharmacy, Chung-Ang University, College of Pharmacy, South Korea
| | - Yun Joo Kim
- The Graduate School Pharmaceutical Management, Chung-Ang University, Seoul 06974, South Korea
| | - Wonku Kang
- Department of Health, Social and Clinical Pharmacy, Chung-Ang University, College of Pharmacy, South Korea
| | - Eun Young Kim
- Evidence Based Research Lab. Department of Health, Social and Clinical Pharmacy, Chung-Ang University, College of Pharmacy, South Korea; The Graduate School Pharmaceutical Management, Chung-Ang University, Seoul 06974, South Korea; Health, Hospital and Clinical Pharmacy, The Graduate School of Food and Drug Administration, Chung-Ang University, Seoul 06974, South Korea.
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Kovacs CS. Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery. Physiol Rev 2016; 96:449-547. [PMID: 26887676 DOI: 10.1152/physrev.00027.2015] [Citation(s) in RCA: 251] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ∼30 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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Affiliation(s)
- Christopher S Kovacs
- Faculty of Medicine-Endocrinology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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Canal-Macias ML, Roncero-Martin R, Moran JM, Lavado-Garcia JM, Costa-Fernandez MDC, Pedrera-Zamorano JD. Increased bone mineral density is associated with breastfeeding history in premenopausal Spanish women. Arch Med Sci 2013; 9:703-8. [PMID: 24049532 PMCID: PMC3776181 DOI: 10.5114/aoms.2013.36903] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 09/19/2012] [Accepted: 11/29/2012] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION During lactation abundant calcium is lost from the mother as a result of the amount of breast milk produced. Lactation leads to transient fragility, with some women experiencing even fragility fractures, but nearly all of these women subsequently undergo a large increase in bone mineral density (BMD), confirming that the BMD must have declined during lactation but it increases after weaning. We have retrospectively examined the relationship between the duration of breastfeeding and bone properties in Spanish premenopausal healthy women, to identify the site-specific changes in BMD. MATERIAL AND METHODS Four hundred and thirty-three premenopausal healthy women, 295 with a mean of 7.82 ±6.68 months of exclusive breastfeeding and 138 control women, were studied. We examined total, trabecular and cortical volumetric BMD (mg/mm(3)) at the distal radius using peripheral quantitative computed tomography. Areal BMD (g/cm(2)) was measured using dual energy X-ray absorptiometry at the femoral neck, lumbar spine, trochanter and Ward's triangle. Phalangeal bone ultrasound was measured by amplitude-dependent speed of sound. RESULTS Areal BMD analysis at L2-L4 revealed significant intergroup differences (p < 0.05). There were significant intergroup differences in the volumetric BMD in both total and cortical bone (p < 0.05). The observed BMD of breast-feeders was higher than the BMD in non-breast-feeding women. Additionally, the lactation subgroup analysis revealed significant differences in the areal BMD at trochanter and L2-L4 (p < 0.05) and in the cortical volumetric BMD (p < 0.05). CONCLUSIONS This study adds to the growing evidence that breastfeeding has no deleterious effects and may confer an additional advantage for BMD in premenopausal women.
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Affiliation(s)
- Maria Luz Canal-Macias
- Metabolic Bone Diseases Research Group (GIEMO), University of Extremadura, School of Nursing and Occupational Therapy, Cáceres, Spain
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Torres de Lacerda AC, Lucena de Vasconcelos MG, Nascimento de Alencar E, Osório MM, Pontes CM. Adolescent fathers: knowledge of and involvement in the breast feeding process in Brazil. Midwifery 2013; 30:338-44. [PMID: 23473910 DOI: 10.1016/j.midw.2013.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 10/16/2012] [Accepted: 01/19/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE to understand the ways in which adolescent fathers participate in the breast feeding process in the family environment in North-eastern Brazil. METHODS a descriptive, exploratory, qualitative study was undertaken involving 10 couples with infants aged 6-8 months living in a single community in Recife, Pernambuco, Brazil. Data were collected using semi-structured interviews with questions to guide the interviewer. Data were analysed using thematic content analysis, and interpreted under the theoretical reference of being an adolescent father within the context of breast feeding. FINDINGS from the data collected, three themes were identified: knowledge of the benefits of breast feeding for the child's health; discontinued participation of the father in breast feeding during the pregnancy-childbearing cycle; and exclusion of the adolescent father from the breast feeding process. The adolescent fathers knew about the benefits of breast feeding in terms of the child's health, but did not mention benefits for the mother, the family or society. For some adolescent fathers, their participation in the breast feeding process started during pregnancy, whereas for others, it was only initiated after the infant was born. One of the fathers was prevented, by his wife and mother-in-law, from participating in the breast feeding process. CONCLUSIONS the involvement of adolescent fathers in the breast feeding process oscillated during the pregnancy-childbearing cycle. This may be due to the patriarchal cultural heritage, Brazilian paternity laws, and the fact that these fathers were adolescents. This study showed that adolescent parents were knowledgeable about breast feeding. Finally, fathers want a new model of parenting in which the man participates in child care.
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Affiliation(s)
- Ana Catarina Torres de Lacerda
- Nursing Department, Universidade Federal de Pernambuco, R-Conselheiro Nabuco 444, Casa Amarela, Recife, PE, CEP: 52070-010, Brazil.
| | | | | | - Mônica Maria Osório
- Nutrition Department, Universidade Federal de Pernambuco, Recife, PE, Brazil
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Abstract
Although the demand for additional calcium during pregnancy is recognized, the dietary reference intake for calcium was lowered for pregnant women in 1997 to amounts recommended for nonpregnant women (1,000 mg/day), and recently (November 2010) the Institute of Medicine report upheld the 1997 recommendation. It has been frequently reported that women of childbearing age do not consume the dietary reference intake for calcium and that calcium intake in the United States varies among ethnic groups. Women who chronically consume suboptimal amounts of calcium (<500 mg/day) may be at risk for increased bone loss during pregnancy. Women who begin pregnancy with adequate intake may not need additional calcium, but women with suboptimal intakes (<500 mg) may need additional amounts to meet both maternal and fetal bone requirements. The objective of this review is to elucidate the changes in calcium metabolism that occur during pregnancy as well as the effect of maternal calcium intake on both maternal and fetal outcomes.
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Affiliation(s)
- Andrea N Hacker
- Children's Hospital Oakland Research Institute, Oakland, California, USA.
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Kurabayashi T, Nagata H, Takeyama N, Matsushita H, Tanaka K. Bone mineral density measurement in puerperal women as a predictor of persistent osteopenia. J Bone Miner Metab 2009; 27:205-12. [PMID: 19172224 DOI: 10.1007/s00774-008-0028-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Accepted: 06/22/2008] [Indexed: 10/21/2022]
Abstract
The clinical value of bone mineral density (BMD) measurement in puerperal women is uncertain. Our aim was to examine the effectiveness of BMD measurement in puerperal women for identification of persistent osteopenia and osteoporosis. We addressed cross-sectional and longitudinal changes in BMD, assessed using dual-energy X-ray absorptiometry (DXA), in a postpartum female cohort from a single center in Japan. We measured BMD of the lumbar spine (L2-L4) with DXA in 2,436 puerperal women within 7 days of delivery (study 1). For 210 of the women, the BMD was measured again after 5-10 years (study 2). In study 1, 8 (0.3%) of the women were osteoporotic, 37 (17.0%) were osteopenic, and 2,013 (82.6%) were normal. In study 2, 27 (71.1%) of the 38 osteoporotic or osteopenic women identified in the puerperal scan were still osteopenic at the scan after 5-10 years. Over the same period, only 7 (4.1%) of 172 initially normal women became osteopenic. The mean of the BMD change per year was 0.15 +/- 0.82%/year. Osteopenia was associated with a significantly lower body weight and body mass index at puerperium and after 5-10 years compared to normal women. The multiple regression analysis showed that BMD at the first scan negatively contributed and body weight changes between the scans positively significantly contributed to the BMD changes per year. Puerperal BMD remained static over the subsequent 5-10 years. If the women have a low BMD at this stage of their reproductive life, it tends not to improve over this time. Perhaps identification of this at-risk group may lead to effective interventions to reduce fracture risk in later life.
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Affiliation(s)
- Takumi Kurabayashi
- Department of Obstetrics and Gynecology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, Niigata 950-1197, Japan.
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Allali F, Maaroufi H, Aichaoui SE, Khazani H, Saoud B, Benyahya B, Abouqal R, Hajjaj-Hassouni N. Influence of parity on bone mineral density and peripheral fracture risk in Moroccan postmenopausal women. Maturitas 2007; 57:392-8. [PMID: 17561361 DOI: 10.1016/j.maturitas.2007.04.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 03/19/2007] [Accepted: 04/22/2007] [Indexed: 12/14/2022]
Abstract
UNLABELLED The aims of the study were to determine: (1) the relationship between parity and bone mineral density (BMD); (2) the relationship between parity and osteoporotic peripheral fractures. MATERIAL AND METHODS The group studied included 730 postmenopausal women. Patients were separated into four groups according to the number of fullterm pregnancies, group 1: nulliparae, group 2: one to three pregnancies, group 3: four to five pregnancies, and group 4: six and more pregnancies. Additionally, patients were separated into three groups according to their ages, as <50 years, 50-59 years and >or=60 years. RESULTS The median parity was 4 [0-20]. All the patients with parity greater than six had spine and hip BMD values significantly lower than values in the other groups (p<0.001). After adjustment for age and body mass index (BMI), decreased lumbar and total hip BMD were still associated to increased parity (analysis of covariance (ANCOVA), p=0.04 and 0.023, respectively). The relation between parity and lumbar BMD was highly significant among women aged <50 years (age-adjusted p=0.022), while there was no parity-spine BMD association in the other age groups. The relation between parity and hip BMD was seen only in the group 50-59 years (age-adjusted p=0.042). A positive history for peripheral fractures was present in 170 (23%) patients. There was relationship between parity and peripheral fractures neither in the whole population nor in the sub-groups according to age. DISCUSSION The present study suggests that the BMD of the spine and hip decreases with an increasing number of pregnancies, and this situation shows variations in different age groups. However, there was no correlation between parity level and peripheral fractures.
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Affiliation(s)
- Fadoua Allali
- Department of Rheumatology, El Ayachi University Hospital, Sale, Morocco.
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Ozdemir F, Demirbag D, Rodoplu M. Reproductive Factors Affecting the Bone Mineral Density in Postmenopausal Women. TOHOKU J EXP MED 2005; 205:277-85. [PMID: 15718820 DOI: 10.1620/tjem.205.277] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Osteoporosis has been defined as a metabolic bone disease characterized by a loss of bone mineral density (BMD) greater than 2.5 standard deviations below young adult peak bone mass or the presence of fracture. By considering that some factors related to female reproductive system might influence the ultimate risk of osteoporosis, we aimed to investigate if a relationship exists between the present BMD of postmenopausal women with their past and present reproductive characteristics. The present study focused on how BMD could be affected by the following factors in postmenopausal women, such as age at menarche, age at first pregnancy, the number of pregnancies and total breast-feeding time. We reviewed detailed demographic history of 303 postmenopausal women. According to the results of the present study, a negative correlation was found between the number of parities and BMD. The BMD values decreased as the number of pregnancies increased. When the BMD values for lumbar vertebrae 2 and Ward's triangle were investigated, it was observed that a significant difference exists between the women with no child birth and those with more than five parities. There was a significant relationship between age at first pregnancy and BMD values at the lumbar vertebrae 2 and Ward's triangle. Women who had five or more abortions were found to have significantly lower spine BMD values compared to women who had no abortions or women who had one or two abortions. These findings indicate that the increased risk of osteoporosis is associated with the increased number of pregnancies and abortions and higher age at first pregnancy.
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Affiliation(s)
- Ferda Ozdemir
- Physical Medicine and Rehabilitation Department, Trakya University School of Medicine, Edirne, Turkey.
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Oliveri B, Parisi MS, Zeni S, Mautalen C. Mineral and bone mass changes during pregnancy and lactation. Nutrition 2004; 20:235-40. [PMID: 14962693 DOI: 10.1016/j.nut.2003.10.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Beatriz Oliveri
- Sección Osteopatías Médicas, Hospital de Clínicas, Universidad de Buenos Aires, Av. Córdoba 2351, (1120) Buenos Aires, Argentina.
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Abstract
Women lose bone during lactation, and this is an important mechanism to provide calcium for human milk. Bone loss during lactation occurs even in women with high calcium intakes. Lactation-induced bone loss is transient because bone density increases rapidly after weaning. Bone loss during lactation and recovery after weaning are related to ovarian function and the length of postpartum amenorrhea. The recovery of bone after weaning can occur with shortly spaced pregnancies. Women who have breastfed several infants do not have reduced bone density after menopause. Overall, the transient bone loss during lactation does not seem to increase a woman's risk of osteoporotic fracture in her elder years. Further research is needed on special subgroups of women, such as adolescents, women who are vitamin D deficient or have extremely low calcium intakes, and women who have simultaneously breastfed multiple infants to determine whether these women are able to regain sufficient bone mass after lactation to preserve their bone health.
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Affiliation(s)
- Heidi J Kalkwarf
- Division of General and Community Pediatrics, Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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