In a post dated 11/6/99 I mentioned an article regarding lactation &
osteoporosis at http://www.obgyn.net/pb/pb.htm

I contacted the author with my concerns about the care this mom was
given.  Dr. Bianchi has kindly agreed to allow me to share her response
with you.
I would be interested to know what you think.

Dear Dr. Bianchi,
I was horrified that this poor woman was given no analgesics for pain
because she was breastfeeding.  There is absolutely no contraindication
for pain relief while nursing.  Good heavens, think of the C/S rate
and the number of those moms who breastfeed!  I would certainly
encourage her PCP to obtain a copy of Tom Hale, PhD's book, "Medications
and Mothers Milk".  Such ignorance and consequent suffering is
inexcusable.

Do you feel that this woman's nutritional status prior to pregnancy, as
regards to calcium intake, was the primary cause of her condition?  I
am aware of studies which have shown that a temporary loss of bone
density does sometimes occur during lactation, but that it returns to
normal and usually improved condition when weaning occurs.
Denny Rice, RN, IBCLC

Dear Ms Rice,
I saw the patient some months after the vertebral fractures. The problem
was that these were not diagnosed, and her pain was much underestimated
by her doctor who thought she exaggerated it.

Regarding her condition, data about pregnancy-associated osteoporosis
(PAO) are relatively scarce, because this condition is rare. This
particular form of osteoporosis generally appears during the last
trimester of the first pregnancy or during lactation. The cause is not
known: probably the mechanisms normally preserving the mother’s skeleton
during pregnancy are not activated. The disease appears to be self
limited:
after pregnancy and lactation there is no more loss of bone mass. In
the experience of most researchers - including myself - the disease will
not appear in a second pregnancy, or will be much less important (but
please note that this experience is based on very few cases). All these
doctors agree that lactation should be discouraged, because it might
favour calcium loss from the mother’s bone. Generally, no medication is
needed, as a substantial recovery of bone mass is the norm after
pregnancy and lactation. Of course, vertebral fractures lead to a
permanent deformity of the affected vertebrae.

Denny Rice RN, IBCLC
Dallas, Texas, USA
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