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Parity and lactation are not associated with incident fragility fractures or radiographic vertebral fractures over 16 years of follow-up: Canadian Multicentre Osteoporosis Study (CaMos)

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Abstract

Summary

Parity and lactation showed no associations with incident clinical fragility fractures or radiographic vertebral compression fractures in the 16-year CaMos prospective study. Parity was associated with slightly greater decline in femoral neck but not hip or spine areal bone mineral density (aBMD), while lactation showed no associations with aBMD change.

Purpose

Pregnancy and especially lactation cause loss of bone mass and microarchitectural changes, which temporarily increase fracture risk. After weaning, aBMD increases but skeletal microarchitecture may be incompletely restored. Most retrospective clinical studies found neutral or even protective associations of parity and lactation with fragility fractures, but prospective data are sparse. CaMos is a randomly selected observational cohort that includes ~ 6500 women followed prospectively for over 16 years.

Methods

We determined whether parity or lactation were related to incident clinical fragility fractures over 16 years, radiographic (morphometric and morphologic) vertebral fractures over 10 years, and aBMD change (spine, total hip, and femoral neck) over 10 years. Parity and lactation duration were analyzed as continuous variables in predicting these outcomes using univariate and multivariate regression analyses.

Results

Three thousand four hundred thirty-seven women completed 16 years of follow-up for incident clinical fractures, 3839 completed 10 years of morphometric vertebral fracture assessment, 3788 completed 10 years of morphologic vertebral fracture assessment, and 4464 completed 10 years of follow-up for change in aBMD. In the multivariate analyses, parity and lactation duration showed no associations with clinical fragility fractures, radiographic vertebral fractures, or change in aBMD, except that parity associated with a probable chance finding of a slightly greater decline in femoral neck aBMD.

Conclusions

Parity and lactation have no adverse associations with clinical fragility or radiographic vertebral fractures, or the rate of BMD decline over 10 years, in this prospective, multicenter study of a randomly selected, population-based cohort of women.

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Acknowledgments

We thank all of the CaMos participants who made this study possible. We also thank CaMos statistician Claudie Berger for compiling the data files and her advice. Preliminary analyses were presented at the American Society for Bone and Mineral Research annual scientific meeting in Denver, Colorado, in September 2017, and at the Diabetes Canada/Canadian Society of Endocrinology and Metabolism conference in Edmonton, Alberta, in October 2017. The first author received a Travel Award from DC/CSEM.

CaMos Research Group: David Goltzman (co-principal investigator, McGill University), Nancy Kreiger (co-principal investigator, Toronto), Alan Tenenhouse (principal investigator emeritus, Toronto). CaMos Coordinating Centre, McGill University, Montreal, Quebec: Suzanne Godmaire (research assistant), Silvia Dumont (administrative assistant), Claudie Berger (study statistician). Memorial University, St. John’s Newfoundland: Carol Joyce (director), Christopher Kovacs (co-director), Krista Rideout (coordinator). Dalhousie University, Halifax, Nova Scotia: Susan Kirkland, Stephanie Kaiser (co-directors), Barbara Stanfield (coordinator). Laval University, Quebec City, Quebec: Jacques P Brown (director), Louis Bessette (co-director), Jeanette Dumont (coordinator). Queen’s University, Kingston, Ontario: Tassos Anastassiades (director), Tanveer Towheed (co-director), Wilma Hopman (researcher), Karen Rees-Milton (coordinator). University of Toronto, Toronto, Ontario: Robert Josse (director), Angela M Cheung (co-director), Barbara Gardner-Bray (coordinator). McMaster University, Hamilton, Ontario: Jonathan D Adachi (director), Alexandra Papaioannou (co-director), Laura Pickard (coordinator). University of Saskatchewan, Saskatoon, Saskatchewan: Wojciech P Olszynski (director), K Shawn Davison (co-director), Jola Thingvold (coordinator). University of Calgary, Calgary, Alberta: David A Hanley (director), Jane Allan (coordinator). University of British Columbia, Vancouver, British Columbia: Jerilynn C Prior (director), Shirin Kalyan (co-director), Brian Lentle (researcher/radiologist), Bernice Liang (coordinator) and Millan Patel (genetics research collaborator). McGill University, Montreal, Quebec: Elham Rahme (biostatistician), Brent Richards (researcher), Suzanne Morin (researcher). University of Alberta, Edmonton, Alberta: Stuart Jackson (medical physicist). University of Manitoba, Winnipeg, Manitoba: William D Leslie (researcher/nuclear medicine physician).

Funding

CaMos is currently funded by the Canadian Institutes of Health Research (CIHR) and Amgen. The funding sources played no role in the data collection, analysis, or interpretation of the results.

Authors’ contributions

Study design: SCH, ZG, GM, JCP, CSK. Study conduct: SCH, ZG, GM, JCP, CSK. Data collection: SCH, SMK, DG, WDL, KSD, JPB, LP, BL, JCP, CSK. Data analysis: SCH, ZG, WDL, CSK. Data interpretation: all authors. Drafting manuscript: SCH and CSK. All authors have revised the manuscript content and approved the final version. CSK takes responsibility for the integrity of the data analysis.

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Authors and Affiliations

  1. Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John’s, NL, A1B 3V6, Canada

    Sandra Cooke-Hubley, Zhiwei Gao, Gerald Mugford & Christopher S. Kovacs

  2. Department of Medicine, Dalhousie University, Halifax, NS, B3H 2Y9, Canada

    Stephanie M. Kaiser

  3. Department of Medicine, McGill University, Montreal, QC, H4A 3J1, Canada

    David Goltzman

  4. Department of Medicine, University of Manitoba, Winnipeg, MB, R2H 2A6, Canada

    William D. Leslie

  5. a priori medical sciences Inc., Victoria, BC, V8R 3E3, Canada

    K. Shawn Davison

  6. Department of Medicine, Division of Rheumatology, CHU de Quebec Research Centre, Laval University, Quebec City, QC, G1V 4G2, Canada

    Jacques P. Brown

  7. Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4R 1K5, Canada

    Linda Probyn

  8. Department of Radiology, University of British Columbia, Vancouver, BC, V9A 6T5, Canada

    Brian Lentle

  9. Centre for Menstrual Cycle and Ovulation Research, Medicine/Endocrinology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada

    Jerilynn C. Prior

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  1. Sandra Cooke-Hubley
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  2. Zhiwei Gao
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  12. Christopher S. Kovacs
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Correspondence to Christopher S. Kovacs.

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Cooke-Hubley, S., Gao, Z., Mugford, G. et al. Parity and lactation are not associated with incident fragility fractures or radiographic vertebral fractures over 16 years of follow-up: Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos 14, 49 (2019). https://doi.org/10.1007/s11657-019-0601-6

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