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Spine bone mineral density increases after 6 months of exclusive lactation, even in women who keep breastfeeding

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Abstract

Summary

This pilot study enrolled 31 women who had breastfed exclusively for 6 months. Lumbar and thoracic BMD increased 4 and 5%, respectively. Femoral neck and total body BMD did not change. Return of menses and progestin-only pill use were two potential signals that predicted a greater increase in BMD.

Purpose/introduction

The skeleton is resorbed during lactation to provide much of the calcium content of milk. After lactation ceases, these deficits in skeletal mineral content are largely restored, such that lactation has a neutral or protective effect against the long-term risk of low bone mineral density (BMD), osteoporosis, and fragility fractures. We hypothesized that a large observational study may identify the factors that predict a greater increase in BMD after lactation ceases. A pilot study was first needed to test feasibility and the magnitude of expected BMD change.

Methods

We undertook Factors Affecting Bone formation after Breastfeeding Pilot (FABB Pilot), which enrolled women who had breastfed exclusively for 6 months and planned to wean soon. The main outcome was change in BMD between enrolment and 6 months later.

Results

Thirty-one women were recruited and completed both time points. Lumbar and thoracic spine BMD increased 4 and 5%, respectively; there was no significant change in femoral neck and total body BMD. Most women did not wean their babies as planned but continued to breastfeed multiple times per day. Despite this, a significant increase in BMD was seen in the subsequent 6 months. Return of spontaneous menses and use of a progestin-only pill at recruitment were two potential signals that predicted a greater increase in BMD during the 6 months after exclusive lactation.

Conclusions

Spine BMD increased significantly during 6 months following exclusive lactation and despite continued lactation. The factors that stimulate skeletal recovery remain to be identified.

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Acknowledgements

Michael Wahl, MSc, and Janine Woodrow, PhD, contributed to the early development of the FABB Protocol. Bernadette Rowe, RN, and Minnie Parsons, RN, coordinated the primary ethics submission and assisted SCH with the subject visits and blood draws. Carolyn Leckie, RN, coordinated the ethics submission in Hamilton and study subject visits. Jessica Kobluk and Chrissy Wells assisted SCH with data entry and verification. Patricia M. Ho did the PTHrP assay.

Funding information

This study received a Dean’s Innovation Award, Faculty of Medicine, Memorial University of Newfoundland (to SCH and CSK) and Canadian Institutes of Health Research (#133413, to CSK).

Author information

Authors and Affiliations

  1. Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada

    Sandra Cooke-Hubley, Beth J. Kirby, James E. Valcour, Gerald Mugford & Christopher S. Kovacs

  2. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Jonathan D. Adachi

  3. Health Sciences Centre, 300 Prince Philip Drive, St. John’s, NL, A1B 3V6, Canada

    Christopher S. Kovacs

Authors
  1. Sandra Cooke-Hubley
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  2. Beth J. Kirby
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  3. James E. Valcour
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  4. Gerald Mugford
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  5. Jonathan D. Adachi
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  6. Christopher S. Kovacs
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Corresponding author

Correspondence to Christopher S. Kovacs.

Ethics declarations

The Health Research Ethics Board of Newfoundland and Labrador approved the study protocol (#13.257); the Hamilton Integrated Research Ethics Board approved the secondary site.

Conflicts of interest

SCH, BJK, JEV, GM, and CSK report no conflicts of interest with this work. JDA reports no conflicts of interest with this work, but financial considerations unrelated to this work (grants and/or honoraria from Amgen, Eli Lilly, Merck, and Agnovos).

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Précis

An observational study which found that lumbar and thoracic spine BMD increased 4 and 5%, respectively, in the 6 months following exclusive lactation, and despite continued lactation. Cooke-Hubley et al.

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Cooke-Hubley, S., Kirby, B.J., Valcour, J.E. et al. Spine bone mineral density increases after 6 months of exclusive lactation, even in women who keep breastfeeding. Arch Osteoporos 12, 73 (2017). https://doi.org/10.1007/s11657-017-0368-6

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  • DOI: https://doi.org/10.1007/s11657-017-0368-6

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