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      The effect of breast-feeding duration on bone mineral density in postmenopausal Turkish women: a population-based study

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          Abstract

          Introduction

          In the present study, we investigated the effects of breast-feeding time on bone mineral density (BMD) later in life.

          Material and methods

          The current study was based on a retrospective analysis of 586 postmenopausal women with a mean age of 60.8 years, who were screened for osteoporosis by dual energy X-ray absorptiometry (DXA).They were classified into 4 groups with respect to the duration of their breast-feeding as never (group 1), 1-24 months (group 2), 25-60 months (group 3), or > 60 months (group 4). Bone mineral density results for the femur neck and lumbar spine were classified into 3 groups according to WHO criteria as normal ( T score > –1.0 SD), osteopenia ( T score –1.0 to –2.5 SD), and osteoporosis ( T score < –2.5 SD). Patients with osteopenia or osteoporosis ( T score < –1.0 SD) were considered as having low bone mass (LBM).

          Results

          We found a correlation between duration of lactation and femur BMD or spine BMD in the study population ( r = 0.116, p < 0.005; r = –0.151, p = 0.001, respectively). Significant differences were found between femur BMD and spine BMD of groups in one-way ANOVA analysis ( p = 0.025, p = 0.005, respectively). Additionally, when compared with the other three groups, group 4 was older and had longer duration of menopause ( p < 0.01). In logistic regression analysis, age and body mass index were found as independent risk factors of LBM [odds ratio: 1.084 (95% CI 1.031-1.141); odds ratio: 0.896 (95% CI 0.859-0.935)], while duration of lactation was not found as an independent predictor of LBM.

          Conclusions

          In this study, we have found that changes of bone metabolism during lactation had no effect on postmenopausal BMD measured by DXA. Consequently, it can be suggested that long breast-feeding duration is not a risk factor for low bone mass later in life.

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          Most cited references31

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          Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society.

          (2015)
          To update the evidence-based position statement published by The North American Menopause Society (NAMS) in 2002 regarding the management of osteoporosis in postmenopausal women. NAMS followed the general principles established for evidence-based guidelines to create this updated document. A panel of clinicians and researchers expert in the field of metabolic bone diseases and/or women's health were enlisted to review the 2002 NAMS position statement, compile supporting statements, and reach consensus on recommendations. The panel's recommendations were reviewed and approved by the NAMS Board of Trustees. Osteoporosis, whose prevalence is especially high among elderly postmenopausal women, increases the risk of fractures. Hip and spine fractures are associated with particularly high morbidity and mortality in this population. Given the health implications of osteoporotic fractures, the primary goal of osteoporosis therapy is to prevent fractures, which is accomplished by slowing or stopping bone loss, maintaining bone strength, and minimizing or eliminating factors that may contribute to fractures. The evaluation of postmenopausal women for osteoporosis risk requires a medical history, physical examination, and diagnostic tests. Major risk factors for postmenopausal osteoporosis (as defined by bone mineral density) include advanced age, genetics, lifestyle factors (such as low calcium and vitamin D intake, smoking), thinness, and menopause status. The most common risk factors for osteoporotic fracture are advanced age, low bone mineral density, and previous fracture as an adult. Management focuses first on nonpharmacologic measures, such as a balanced diet, adequate calcium and vitamin D intake, adequate exercise, smoking cessation, avoidance of excessive alcohol intake, and fall prevention. If pharmacologic therapy is indicated, government-approved options are bisphosphonates, a selective estrogen-receptor modulator, parathyroid hormone, estrogens, and calcitonin. Management strategies for postmenopausal women involve identifying those at risk of low bone density and fracture, followed by instituting measures that focus on reducing modifiable risk factors through lifestyle changes and, if indicated, pharmacologic therapy.
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            Bone mineral loss during lactation and recovery after weaning.

            To test the hypothesis that bone mineral content (BMC) and density (BMD) are lost during lactation and regained within 6 months after weaning. Two cohorts of women, defined by time postpartum, were enrolled into the study; each cohort was followed for 6 months. Women in the lactation cohort (65 lactating women and 48 nonlactating postpartum controls) were enrolled at 2 weeks postpartum. Women in the weaning cohort (40 lactating and 43 nonlactating postpartum controls) were enrolled at 4-6 months postpartum. Lactating women enrolled in the weaning cohort had been fully breast-feeding at enrollment and weaned within 2 months of enrollment. Bone mineral content of the total body and BMD of the lumbar spine and distal radius were measured by dual-energy x-ray absorptiometry. Lactating women lost significantly more bone in the total body (-2.8 versus -1.7%) and lumbar spine (-3.9 versus 1.5%) than did nonlactating women during the first 6 months postpartum. There was no effect of lactation on bone changes at the distal radius. After weaning, lactating women gained significantly more bone in the lumbar spine than did nonlactating women (5.5 versus 1.8%). Earlier resumption of menses was associated with a smaller loss of bone during lactation and a greater increase of bone after weaning. Women lose bone during lactation but gain bone after weaning. Thus, lactation may not result in net bone loss.
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              Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women.

              The objective of this population-based case-control study was to clarify the relationships between parity, breastfeeding and ages at menarche and menopause and the risk of hip fracture among elderly women. The study base comprised women aged 65 years and over living in a defined region in Sydney, Australia, during 1990-1991. Cases (n = 174) were recruited from 12 hospitals and controls (n = 137) were selected using an area probability sampling method, with additional sampling from nursing homes. The age- and proxy-adjusted odds ratio (OR) comparing parous women who had never breastfed with nulliparous women was 2.11 (95% confidence interval (CI): 0.85-5.25). Among parous women, the age- and proxy-adjusted OR for ever versus never breastfeeding was 0.47 (95% CI: 0.22-0.99). There was a dose-response relationship between average duration of breastfeeding per child and risk of hip fracture (test for trend: P < 0.01). Age at menopause and age at menarche were only weakly associated with hip fracture risk. This study suggests that breastfeeding may protect parous women against hip fracture in old age.
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                Author and article information

                Journal
                Arch Med Sci
                AMS
                Archives of Medical Science : AMS
                Termedia Publishing House
                1734-1922
                1896-9151
                June 2011
                11 July 2011
                : 7
                : 3
                : 486-492
                Affiliations
                [1 ]Physical Therapy Rehabilitation Clinic, Düzce Medical Faculty, Düzce, Turkey
                [2 ]Department of Internal Medicine, Düzce Medical Faculty, Düzce, Turkey
                [3 ]Department of Nuclear Medicine, Düzce Medical Faculty, Düzce, Turkey
                Author notes
                Corresponding author: Dr Selma Yazici, Department of Physical Medicine and Rehabilitation, Abant Izzet Baysal, University Medical Faculty, Golkoy, 14280 Bolu, Turkey, Phone: 0 374 253 46 56, Fax: 0 374 253 52 36. E-mail: drselmayazici@ 123456yahoo.com
                Article
                AMS-7-3-486
                10.5114/aoms.2011.23416
                3258757
                22295033
                181dd8d8-69b7-4653-b2ff-1a40e8dc914e
                Copyright © 2011 Termedia & Banach

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 July 2010
                : 10 September 2010
                : 9 October 2010
                Categories
                Clinical Research

                Medicine
                breast-feeding time,bone mineral density,postmenopausal women
                Medicine
                breast-feeding time, bone mineral density, postmenopausal women

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