Effects of multiparity and duration of breast-feeding on maternal bone mineral density in post-menopausal Kurdish women: A retrospective study

Document Type: Original Article

Authors

1 Department of Radiology and Nuclear Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran

2 Department of Radiology, Paramedical Faculty, Kurdistan University of Medical Sciences, Sanandaj, Iran

3 Department of Environmental Health, Health Faculty, Kurdistan University of Medical Sciences, Sanandaj, Iran

Abstract

Introduction:There is considerable amount of controversy about the long term effects of multiparity and duration of breast-feeding on maternal bone mineral density after menopause. This study was conducted to determine whether multiple pregnancy and prolonged duration of breast-feeding are independent predictors of low bone mass in post-menopausal Kurdish women.
Methods: In a retrospective study, we evaluated 991 post-menopausal women with mean age of 58.9 years screened for osteoporosis by dual energy X-ray absorptiometry (DXA). According to the parity (1-2, 3-4, 5-7, >7 children) and total duration of breast-feeding (1-24, 25-60, 61-96, >96 months) they were classified. Bone mineral density (BMD) results for femoral neck and lumbar spine were classified into three groups (normal, osteopenia, and osteoporosis) according to the WHO criteria. Binary logistic regression was used to assess the independent associations of low femur or spine BMD with parity and total duration of breast-feeding.
Results: We found that women with 5 or more children and having more than 60 months history of total breast-feeding, were older (p<0.001) with higher prevalence of osteoporosis (p<0.001). However, after adjusting for age only parity was independent predictor for osteopenia (OR: 1.336; 95% CI 1.29-1.735) while total duration of breast-feeding was not an independent predictor of low bone mass.

Conclusion: Multiparity has a detrimental effect on maternal BMD. History of multiple pregnancy is a risk factor for low bone mass in post-menopausal women. However, prolonged duration of breast-feeding has no long-term adverse effect on maternal BMD in post-menopausal age.

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  1. Pagès-Castellà A, Carbonell-Abella C, Avilés FF, Alzamora M, Baena-Díez JM, Laguna DM, Nogués X, Díez-Pérez A, Prieto-Alhambra D.. Burden of osteoporotic fractures in primary health care in Catalonia (Spain): a population-based study. BMC Musculoskelet Disord. 2012 May 28;13:79.
  2. Oliveri B, Parisi MS, Zeni S, Mautalen C. Mineral and bone mass changes during pregnancy and lactation. Nutrition. 2004 Feb;20(2):235-40.
  3. Hopkinson JM, Butte NF, Ellis K, Smith EO. Lactation delays postpartum bone mineral accretion and temporarily alters its regional distribution in women. J Nutr. 2000 Apr;130(4):777-83.
  4. Kalkwarf HJ, Specker BL. Bone mineral loss during lactation and recovery after weaning. Obstet Gynecol. 1995 Jul;86(1):26-32.
  5. Bayray A, Enquselassie F. The effect of parity on bone mineral density in post-menopausal women: A systematic review. J Osteopor Phys Act. 2013;1:104.
  6. Santos Goncalves AC, de Figueiredo Ferreira M, Hasselmann MH, Faerstein E. The effect of breast-feeding on bone mass of post-menopausal women: A systematic review of observational studies. Rev Bras Saude Mater Infant. 2015;15(3): 265-278.
  7. Tsvetov G, Levy S, Benbassat C, Shraga-Slutzky I, Hirsch D. Influence of number of deliveries and total breast-feeding time on bone mineral density in premenopausal and young postmenopausal women. Maturitas. 2014 Mar;77(3):249-54.
  8. Bolzetta F, Veronese N, De Rui M, Berton L, Carraro S, Pizzato S, Girotti G, De Ronch I, Manzato E, Coin A, Sergi G. Duration of breastfeeding as a risk factor for vertebral fractures. Bone. 2014 Nov;68:41-5.
  9. Sawo Y, Jarjou LM, Goldberg GR, Laskey MA, Prentice A. Bone mineral changes after lactation in Gambian women accustomed to a low calcium intake. Eur J Clin Nutr. 2013 Nov;67(11):1142-6.
  10. Kalkwarf HJ, Specker BL. Bone mineral changes during pregnancy and lactation. Endocrine. 2002 Feb;17(1):49-53.
  11. Salari P, Abdollahi M. The influence of pregnancy and lactation on maternal bone health: a systematic review. J Family Reprod Health. 2014 Dec;8(4):135-48.
  12. Schnatz PF, Barker KG, Marakovits KA, O'Sullivan DM. Effects of age at first pregnancy and breast-feeding on the development of postmenopausal osteoporosis. Menopause. 2010 Nov-Dec;17(6):1161-6.
  13. Specker B, Binkley T. High parity is associated with increased bone size and strength. Osteoporos Int. 2005 Dec;16(12):1969-74.
  14. Schnatz PF, Marakovits KA, O'Sullivan DM. Assessment of postmenopausal women and significant risk factors for osteoporosis. Obstet Gynecol Surv. 2010 Sep;65(9):591-6.
  15. O'Brien KO, Nathanson MS, Mancini J, Witter FR. Calcium absorption is significantly higher in adolescents during pregnancy than in the early postpartum period. Am J Clin Nutr. 2003 Dec;78(6):1188-93.
  16. O'Brien KO, Donangelo CM, Zapata CL, Abrams SA, Spencer EM, King JC. Bone calcium turnover during pregnancy and lactation in women with low calcium diets is associated with calcium intake and circulating insulin-like growth factor 1 concentrations. Am J Clin Nutr. 2006 Feb;83(2):317-23.
  17. Kovacs CS. Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab. 2001 Jun;86(6):2344-8.
  18. Cross NA, Hillman LS, Allen SH, Krause GF, Vieira NE. Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. Am J Clin Nutr. 1995 Mar;61(3):514-23.
  19. Karlsson MK, Ahlborg HG, Karlsson C. Female reproductive history and the skeleton-a review. BJOG. 2005 Jul;112(7):851-6.
  20. Karlsson C, Obrant KJ, Karlsson M. Pregnancy and lactation confer reversible bone loss in humans. Osteoporos Int. 2001;12(10):828-34.
  21. Hosseinpanah F, Sorouri M, Rambod M, Azizi F. Total duration of breastfeeding is associated with low bone mineral density in Iranian postmenopausal women. Int J Endocrinol Metab. 2010;8(3):153-158.
  22. Heidari B, Heidari P, Nourooddini HG, Hajian-Tilaki KO. Relationship between parity and bone mass in postmenopausal women according to number of parities and age. J Reprod Med. 2013 Sep-Oct;58(9-10):389-94.
  23. Stieglitz J, Beheim BA, Trumble BC, Madimenos FC, Kaplan H, Gurven M. Low mineral density of a weight-bearing bone among adult women in a high fertility population. Am J Phys Anthropol. 2015 Apr;156(4):637-48.
  24. Alam IP, Haque MA, Chowdhury SB. Influence of number of parity on bone mineral density among postmenopausal women. J Bangladesh Coll Phys Surg. 2015;33(2):75-78.
  25. Lenora J, Lekamwasam S, Karlsson MK. Effects of multiparity and prolonged breast-feeding on maternal bone mineral density: a community-based cross-sectional study. BMC Womens Health. 2009 Jul 1;9:19.
  26. Streeten EA, Ryan KA, McBride DJ, Pollin TI, Shuldiner AR, Mitchell BD. The relationship between parity and bone mineral density in women characterized by a homogeneous lifestyle and high parity. J Clin Endocrinol Metab. 2005 Aug;90(8):4536-41.
  27. Lekamwasam S, Wijayaratne L, Rodrigo M, Hewage U. Effect of parity on phalangeal bone mineral density in post-menopausal Sri Lankan women: a community based cross-sectional study. Matern Child Nutr. 2009 Apr;5(2):179-85.
  28. Kayani BA, Shah SH, Mumtaz N, Saleem M. Association of lactation with postmenopausal low bone mineral density. Rawa Med J. 2013;38(4):393-96.
  29. Yazici S, Korkmaz U, Erkan M, Korkmaz N, Erdem Baki A, Alçelik A, Onder E, Atao─člu S. The effect of breast-feeding duration on bone mineral density in postmenopausal Turkish women: a population-based study. Arch Med Sci. 2011 Jun;7(3):486-92. 
  30. Kim HJ, Kwon H, Oh SW, Lee CM, Joh HK, Kim Y, Um YJ, Ahn SH. Breast feeding is associated with postmenopausal bone loss: findings from the korea national health and nutrition examination survey. Korean J Fam Med. 2015 Sep;36(5):216-20.
  31. Hwang IR, Choi YK, Lee WK, Kim JG, Lee IK, Kim SW, Park KG. Association between prolonged breastfeeding and bone mineral density and osteoporosis in postmenopausal women: KNHANES 2010-2011. Osteoporos Int. 2016 Jan;27(1):257-65.
  32. Eftekhari M, Asadollahi A, Beiki D, Izadyar S, Gholamrezanezhad A, Assadi M, Fard-Esfahani A, Fallahi B, Takavar A, Saghari M. The long term effect of levothyroxine on bone mineral density in patients with well differentiated thyroid carcinoma after treatment. Hell J Nucl Med. 2008 Sep-Dec;11(3):160-3.