Osteoporosis International

, Volume 28, Issue 2, pp 495–503 | Cite as

A meta-analysis of breastfeeding and osteoporotic fracture risk in the females

  • X. Duan
  • J. Wang
  • X. JiangEmail author
Original Article



Our meta-analysis included 12 studies from PubMed, Embase, and Web of Science. Finding indicated breastfeeding may well reduce the risk of osteoporotic fracture.


Several epidemiologic studies have investigated that breastfeeding is associated with short-term bone loss in the women, but the long-term effect on osteoporotic fracture risk remains unclear. Thus, we conducted this meta-analysis to explore the potential association between breastfeeding and osteoporotic fracture risk in the females and possible dose-response relationship between them.


We searched PubMed, Embase, and Web of Science (ISI) up to April 2016 for relevant articles associated between breastfeeding and osteoporotic fracture. Pooled relative risks (RRs) with 95 % confidence intervals (CIs) were calculated with a random-effects model. Dose-response analysis was performed by restricted cubic spline.


Twelve articles including 14,954 participants were identified. The pooled RRs of osteoporotic hip and forearm fracture for the highest vs lowest duration of breastfeeding were 0.84 (95 % CI 0.67–1.05), 0.72 (95 % CI 0.52–0.99), and 0.82 (95 % CI 0.56–1.19), respectively. In subgroup analysis, breastfeeding was associated with a decreased risk of osteoporotic fracture in case-control study (RR = 0.70, 95 % CI 0.49–0.99) and postmenopausal women (RR = 0.66, 95 % CI 0.47–0.93). In dose-response analysis, osteoporotic and hip fracture risk decreased by 0.9 and 1.2 % for each month increment of breastfeeding, respectively.


Our meta-analysis revealed that breastfeeding may well reduce the risk of osteoporotic fracture. More cohort studies with large sample sizes are needed to confirm the conclusion.


Breastfeeding Hip fracture Lactation Meta-analysis Osteoporotic fracture 



The authors would like to express their gratitude to the Department of Epidemiology and Health Statistics, the Medical College of Qingdao University.

Compliance with ethical standards

Conflicts of interest


Supplementary material

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  1. 1.
    Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767. doi: 10.1016/s0140-6736(02)08657-9 CrossRefPubMedGoogle Scholar
  2. 2.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733. doi: 10.1007/s00198-006-0172-4 CrossRefPubMedGoogle Scholar
  3. 3.
    Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7(5):407–413CrossRefPubMedGoogle Scholar
  4. 4.
    Kang HY, Kang DR, Jang YH, Park SE, Choi WJ, Moon SH, Yang KH (2008) Estimating the economic burden of osteoporotic vertebral fracture among elderly Korean women. Journal of preventive medicine and public health = Yebang Uihakhoe chi 41(5):287–294. doi: 10.3961/jpmph.2008.41.5.287 CrossRefPubMedGoogle Scholar
  5. 5.
    Singer A, Exuzides A, Spangler L, O'Malley C, Colby C, Johnston K, Agodoa I, Baker J, et al. (2015) Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. Mayo Clin Proc 90(1):53–62. doi: 10.1016/j.mayocp.2014.09.011 CrossRefPubMedGoogle Scholar
  6. 6.
    Johansson H, Kanis JA, Oden A, McCloskey E, Chapurlat RD, Christiansen C, Cummings SR, Diez-Perez A, et al. (2014) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 29(1):223–233. doi: 10.1002/jbmr.2017 CrossRefPubMedGoogle Scholar
  7. 7.
    Moayyeri A (2008) The association between physical activity and osteoporotic fractures: a review of the evidence and implications for future research. Ann Epidemiol 18(11):827–835. doi: 10.1016/j.annepidem.2008.08.007 CrossRefPubMedGoogle Scholar
  8. 8.
    Guan JZ, Wu M, Xiao YZ, Zhou JS, Wang ZD (2014) MTHFR C677T polymorphism and osteoporotic fracture in postmenopausal women: a meta-analysis. Genetics and molecular research : GMR 13(3):7356–7364. doi: 10.4238/2014.September.12.1 CrossRefPubMedGoogle Scholar
  9. 9.
    Handel MN, Heitmann BL (2015) Nutrient and food intakes in early life and risk of childhood fractures: a systematic review and meta-analysis. 102(5):1182–1195. doi: 10.3945/ajcn.115.108456
  10. 10.
    Wang Q, Huang Q, Zeng Y, Liang J, Liu Sy GX, Ja L (2016) Parity and osteoporotic fracture risk in postmenopausal women: a dose-response meta-analysis of prospective studies. Osteoporos Int 27(1):319–330. doi: 10.1007/s00198-015-3351-3 CrossRefPubMedGoogle Scholar
  11. 11.
    Zhan B, Liu X, Li F, Zhang D (2015) Breastfeeding and the incidence of endometrial cancer: a meta-analysis. Oncotarget 6(35):38398–38409. doi: 10.18632/oncotarget.5049 PubMedPubMedCentralGoogle Scholar
  12. 12.
    Zhou Y, Chen J, Li Q, Huang W, Lan H, Jiang H (2015) Association between breastfeeding and breast cancer risk: evidence from a meta-analysis. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine 10(3):175–182. doi: 10.1089/bfm.2014.0141 CrossRefGoogle Scholar
  13. 13.
    Jager S, Jacobs S, Kroger J, Fritsche A, Schienkiewitz A, Rubin D, Boeing H, Schulze MB (2014) Breast-feeding and maternal risk of type 2 diabetes: a prospective study and meta-analysis. Diabetologia 57(7):1355–1365. doi: 10.1007/s00125-014-3247-3 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Feng LP, Chen HL, Shen MY (2014) Breastfeeding and the risk of ovarian cancer: a meta-analysis. J Midwifery Womens Health 59(4):428–437. doi: 10.1111/jmwh.12085 CrossRefPubMedGoogle Scholar
  15. 15.
    Kalkwarf HJ (1999) Hormonal and dietary regulation of changes in bone density during lactation and after weaning in women. J Mammary Gland Biol Neoplasia 4(3):319–329CrossRefPubMedGoogle Scholar
  16. 16.
    Holmberg-Marttila D, Sievanen H, Tuimala R (1999) Changes in bone mineral density during pregnancy and postpartum: prospective data on five women. Osteoporos Int 10(1):41–46. doi: 10.1007/s001980050192 CrossRefPubMedGoogle Scholar
  17. 17.
    Akesson A, Vahter M, Berglund M, Eklof T, Bremme K, Bjellerup P (2004) Bone turnover from early pregnancy to postweaning. Acta Obstet Gynecol Scand 83(11):1049–1055. doi: 10.1111/j.0001-6349.2004.00428.x CrossRefPubMedGoogle Scholar
  18. 18.
    Canal-Macias ML, Roncero-Martin R, Moran JM, Lavado-Garcia JM, Costa-Fernandez Mdel C, Pedrera-Zamorano JD (2013) Increased bone mineral density is associated with breastfeeding history in premenopausal Spanish women. Archives of medical science : AMS 9(4):703–708. doi: 10.5114/aoms.2013.36903 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Singh R, Gupta S, Awasthi A (2015) Differential effect of predictors of bone mineral density and hip geometry in postmenopausal women: a cross-sectional study. Arch Osteoporos 10:39. doi: 10.1007/s11657-015-0246-z CrossRefPubMedGoogle Scholar
  20. 20.
    Schnatz PF, Barker KG, Marakovits KA, O'Sullivan DM (2010) Effects of age at first pregnancy and breast-feeding on the development of postmenopausal osteoporosis. Menopause (New York, NY) 17(6):1161–1166. doi: 10.1016/j.bone.2014.08.00110.1097/gme.0b013e3181e0efb3 CrossRefGoogle Scholar
  21. 21.
    Ahn SK, Kam S, Chun BY (2014) Incidence of and factors for self-reported fragility fractures among middle-aged and elderly women in rural Korea: an 11-year follow-up study. Journal of Preventive Medicine and Public Health 47(6):289–297PubMedPubMedCentralGoogle Scholar
  22. 22.
    Bolzetta F, Veronese N, De Rui M, Berton L, Carraro S, Pizzato S, Girotti G, De Ronch I, et al. (2014) Duration of breastfeeding as a risk factor for vertebral fractures. J Osteoporos 68:41–45. doi: 10.1155/2014/89718210.1016/j.bone.2014.08.001 Google Scholar
  23. 23.
    Bjornerem A, Ahmed LA, Jorgensen L, Stormer J, Joakimsen RM (2011) Breastfeeding protects against hip fracture in postmenopausal women: the Tromso study. J Bone Miner Res 26(12):2843–2850. doi: 10.1002/jbmr.496 CrossRefPubMedGoogle Scholar
  24. 24.
    Huo D, Lauderdale DS, Li L (2003) Influence of reproductive factors on hip fracture risk in Chinese women. Osteoporos Int 14(8):694–700. doi: 10.1007/s00198-003-1429-9 CrossRefPubMedGoogle Scholar
  25. 25.
    Naves M, Diaz-Lopez JB, Gomez C, Rodriguez-Rebollar A, Cannata-Andia JB (2005) Determinants of incidence of osteoporotic fractures in the female Spanish population older than 50. Osteoporos Int 16(12):2013–2017. doi: 10.1007/s00198-005-1983-4 CrossRefPubMedGoogle Scholar
  26. 26.
    Alderman BW, Weiss NS, Daling JR, Ure CL, Ballard JH (1986) Reproductive history and postmenopausal risk of hip and forearm fracture. Am J Epidemiol 124(2):262–267CrossRefPubMedGoogle Scholar
  27. 27.
    Stewart LA, Clarke M, Rovers M, Riley RD, Simmonds M, Stewart G, Tierney JF (2015) Preferred reporting items for systematic review and meta-analyses of individual participant data: the PRISMA-IPD statement. JAMA 313(16):1657–1665. doi: 10.1001/jama.2015.3656 CrossRefPubMedGoogle Scholar
  28. 28.
    Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J, Dilsen G, Gennari C, et al. (1995) Risk factors for hip fracture in European women: the MEDOS study. Mediterranean Osteoporosis Study. J Bone Miner Res 10(11):1802–1815. doi: 10.1002/jbmr.5650101125 CrossRefPubMedGoogle Scholar
  29. 29.
    Clark P, de la Pena F, Gomez Garcia F, Orozco JA, Tugwell P (1998) Risk factors for osteoporotic hip fractures in Mexicans. Arch Med Res 29(3):253–257PubMedGoogle Scholar
  30. 30.
    Mallmin H, Ljunghall S, Persson I, Bergstrom R (1994) Risk factors for fractures of the distal forearm: a population-based case-control study. Osteoporos Int 4(6):298–304CrossRefPubMedGoogle Scholar
  31. 31.
    Michaelsson K, Baron JA, Farahmand BY, Ljunghall S (2001) Influence of parity and lactation on hip fracture risk. Am J Epidemiol 153(12):1166–1172CrossRefPubMedGoogle Scholar
  32. 32.
    Hoffman S, Grisso JA, Kelsey JL, Gammon MD, O'Brien LA (1993) Parity, lactation and hip fracture. Osteoporos Int 3(4):171–176CrossRefPubMedGoogle Scholar
  33. 33.
    Chan HH, Lau EM, Woo J, Lin F, Sham A, Leung PC (1996) Dietary calcium intake, physical activity and the risk of vertebral fracture in Chinese. Osteoporos Int 6(3):228–232CrossRefPubMedGoogle Scholar
  34. 34.
    Cumming RG, Klineberg RJ (1993) Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. Int J Epidemiol 22(4):684–691CrossRefPubMedGoogle Scholar
  35. 35.
    Zhu Y, Goff JP, Reinhardt TA, Horst RL (1998) Pregnancy and lactation increase vitamin D-dependent intestinal membrane calcium adenosine triphosphatase and calcium binding protein messenger ribonucleic acid expression. Endocrinology 139(8):3520–3524. doi: 10.1210/endo.139.8.6141 PubMedGoogle Scholar
  36. 36.
    Cross NA, Hillman LS, Allen SH, Krause GF, Vieira NE (1995) Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. Am J Clin Nutr 61(3):514–523PubMedGoogle Scholar
  37. 37.
    Sowers M, Eyre D, Hollis BW, Randolph JF, Shapiro B, Jannausch ML, Crutchfield M (1995) Biochemical markers of bone turnover in lactating and nonlactating postpartum women. J Clin Endocrinol Metab 80(7):2210–2216. doi: 10.1210/jcem.80.7.7608281 PubMedGoogle Scholar
  38. 38.
    Ardeshirpour L, Dann P, Adams DJ, Nelson T, VanHouten J, Horowitz MC, Wysolmerski JJ (2007) Weaning triggers a decrease in receptor activator of nuclear factor-kappaB ligand expression, widespread osteoclast apoptosis, and rapid recovery of bone mass after lactation in mice. Endocrinology 148(8):3875–3886. doi: 10.1210/en.2006-1467 CrossRefPubMedGoogle Scholar
  39. 39.
    Kalkwarf HJ, Specker BL, Heubi JE, Vieira NE, Yergey AL (1996) Intestinal calcium absorption of women during lactation and after weaning. Am J Clin Nutr 63(4):526–531PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  1. 1.Department of Epidemiology and Health Statisticsschool of public health of Qingdao UniversityQingdaoPeople’s Republic of China
  2. 2.Department of Epidemiology and Health Statisticsthe Medical College of Qingdao UniversityQingdaoPeople’s Republic of China

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