by Anne Eglash MD, IBCLC, FABM
Does it or doesn’t it? You know, the decade’s old question of - Does the natural bone remodeling after weaning make the bones stronger to prevent osteoporosis?
No one is disputing that a breastfeeding woman who is not ovulating decreases her bone density by 5-10% (that’s a lot!). When the same woman begins menstruating, her bones regain strength. It was thought that breastfeeding might protect against osteoporosis after menopause because maybe that remodeling during weaning makes the bones stronger. Or so we hoped.
Breastfeeding has been through the wringer when it comes to its role in postmenopausal osteoporosis. Some evidence has shown that breastfeeding protects from osteoporosis, some studies indicate breastfeeding is actually a risk factor for postmenopausal osteoporosis, and some studies have shown no effect from breastfeeding.
The authors of this meta- analysis reviewed 911 articles. Twelve articles with a total of 14,954 participants met their criteria to evaluate the effect of breastfeeding on osteoporosis. They found that breastfeeding reduces the risk of fractures from osteoporosis. They calculated a 0.9% reduction of any fracture from osteoporosis for each month of breastfeeding. More specifically, there is a 1.2% decreased risk of hip fracture for every month of breastfeeding.
According to the authors, how does a breastfeeding mother’s physiology help protect her from bone fractures after menopause?
- Women who are breastfeeding increase their gut absorption of calcium from their diet.
- Women who are breastfeeding decrease their calcium losses in urine.
- Women who nurse for a prolonged time have higher osteocalcin levels, which is a hormone that helps build new bone.
- All of the above
See the Answer
Osteoporos Int. 2016 Aug 30. [Epub ahead of print]
A meta-analysis of breastfeeding and osteoporotic fracture risk in the females.
Duan X - 1
Wang J - 2
Jiang X - 2,3
- Department of Epidemiology and Health Statistics, school of public health of Qingdao University, Qingdao, Shandong Province, People's Republic of China
- Department of Epidemiology and Health Statistics, school of public health of Qingdao University, Qingdao, Shandong Province, People's Republic of China. firstname.lastname@example.org
- Department of Epidemiology and Health Statistics, the Medical College of Qingdao University, 38 Dengzhou Road, Qingdao, Shandong, 266021, People's Republic of China. email@example.com
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.
Read the article
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
Thanks to these authors for another feather in the cap of breastfeeding mothers! I would like to point out that the studies included in this meta-analysis represented a relatively diverse population- 5 were European, 1 Mexican, 2 Chinese, 1 Korean, 2 American and 1 Australian.
As a family physician, I know how impactful osteoporosis is for an individual, family, and our society. In the USA, women are more likely to suffer osteoporosis than men. Women who suffer a hip fracture are more than twice as likely to die.
Besides death, a hip fracture may cause a woman to suffer other complications such as loss of ambulation, which may be accompanied by inability to live independently. As a result, the family may experience financial stress as a result of grandma moving to a skilled or unskilled facility.
So, as for breastfeeding and osteoporosis, the proverbial pendulum has swung again. We have several years in the future to find out where it will hang to rest.