Bone turnover and density in healthy women during breastfeeding and after meaning

To investigate the changes in maternal bone density and turnover associated with lactation we ran a longitudinal study in fully breastfeeding women (age 26.3+/-4.1 years, mean+/-SD) at the first (stage I, n = 30) and sixth (stage II, n = 25) months postpartum and 6 months after weaning (stage III, n = 20), and in a contemporary control group of non-nursing women. At each time point bone density, serum calcium, phosphorus, alkaline phosphatases, parathyroid hormone (PTH), osteocalcin, follicle stimulating hormone (FSH), estradiol (E(2)), prolactin (PRL) urinary hydroxyproline and creatinine (OH-P/Cr) were measured in both groups. The daily calcium intake of nursing women (1479 +/- 590 mg/day at stage I) was higher than in non-nursing women (536 +/- 231 mg/day at stage I). Biochemical markers of bone turnover were higher (p<0.05) in nursing than in non-nursing women at stages I and II, while in stage III only OH-P/Cr was elevated. The lumbar spine (L2-4) bone mineral density was similar in the two groups at the beginning of the study (1.148 +/- 0.111 g/cm(2) in nursing women vs 1.211 +/- 0.102 g/cm(2) in non-nursing women; p = 0.56), but it was lower in nursing women at stage II (1.144 +/- 0.110 g/cm(2) vs 1.216 +/- 0.095 g/cm(2) respectively; p<0.05). Right cm femoral neck bone density decreased by 3% between stages I and II in nursing women but did not differ from values in non-nursing women (0.947 +/- 0.110 vs 0.973 +/- 0.108 in stage I and 0.918 +/- 0.114 vs 0.975 +/- 0.098 in stage II respectively; p<0.05, ANOVA). After weaning, lumbar spine and femoral neck bone density increased by 6% and 8% respectively (p<0.05, ANOVA). No correlation was found between changes in bone turnover markers or bone density and parity, frequency and duration of nursing episodes, body weight, body mass index, and plasma PRL, E(2) and PTH levels. We conclude that in nursing women with a daily calcium intake at the recommended dietary allowance (>1200 mg/day), full breastfeeding extending over 6 months is characterized by increased maternal bone turnover and a transient bone loss which normalizes after weaning.