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LACTNET  September 2016, Week 3

LACTNET September 2016, Week 3

Subject:

The Milk Mob Clinical Question of the Week

From:

Allison Laverty Montag <[log in to unmask]>

Reply-To:

Lactation Information and Discussion <[log in to unmask]>

Date:

Thu, 15 Sep 2016 19:22:27 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (172 lines)

*Breastfeeding and Osteoporosis Fractures in Females*



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?

1.       Women who are breastfeeding increase their gut absorption of
calcium from their diet.

2.       Women who are breastfeeding decrease their calcium losses in urine.

3.       Women who nurse for a prolonged time have higher osteocalcin
levels, which is a hormone that helps build new bone.

4.       All of the above




The answer is 4

Abstract:

Osteoporos Int. <http://www.ncbi.nlm.nih.gov/pubmed/27577724> 2016 Aug 30.
[Epub ahead of print]

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

Duan X
<http://www.ncbi.nlm.nih.gov/pubmed/?term=Duan%20X%5BAuthor%5D&cauthor=true&cauthor_uid=27577724>
1, Wang J
<http://www.ncbi.nlm.nih.gov/pubmed/?term=Wang%20J%5BAuthor%5D&cauthor=true&cauthor_uid=27577724>
1, Jiang X
<http://www.ncbi.nlm.nih.gov/pubmed/?term=Jiang%20X%5BAuthor%5D&cauthor=true&cauthor_uid=27577724>
2,3.

*Author information* <http://www.ncbi.nlm.nih.gov/pubmed/27577724>

·         1Department of Epidemiology and Health Statistics, school of
public health of Qingdao University, Qingdao, Shandong Province, People's
Republic of China.

·         2Department of Epidemiology and Health Statistics, school of
public health of Qingdao University, Qingdao, Shandong Province, People's
Republic of China. [log in to unmask]

·         3Department of Epidemiology and Health Statistics, the Medical
College of Qingdao University, 38 Dengzhou Road, Qingdao, Shandong, 266021,
People's Republic of China. [log in to unmask]



*Abstract*

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

*INTRODUCTION:*

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.

*METHODS:*

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.

*RESULTS:*

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.

*CONCLUSIONS:*

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 <http://www.ncbi.nlm.nih.gov/pubmed/27577724>*





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 <http://www.cdc.gov/nchs/fastats/osteoporosis.htm>*
than men. Women who suffer a hip fracture are more than twice as likely to
die <http://www.ncbi.nlm.nih.gov/pubmed/15086646>.

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.





posted for The Milk Mob by

Allison Laverty Montag IBCLC

Wisconsin, USA

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