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Title: Irreversible deterioration of cortical and trabecular microstructure associated with breastfeeding
Austin Authors: Bjørnerem, Ashild;Ghasem-Zadeh, Ali ;Wang, Xiaofang;Bui, Minh;Walker, Susan P;Zebaze, Roger MD;Seeman, Ego 
Affiliation: Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
Depatment of Obstetrics and Gynaecology, University Hospital of North-Norway, Tromsø, Norway
Endocrine Centre and Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
Mercy Hospital for Women, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Health and Ageing, Australian Catholic University, Melbourne, Australia
Issue Date: Apr-2017 2016-10-13
Publication information: Journal of Bone and Mineral Research 2016; 32(4): 681-687
Abstract: Estrogen deficiency associated with menopause is accompanied by an increase in the rate of bone remodeling and the appearance of a remodeling imbalance; each of the greater number of remodeling transactions deposits less bone than was resorbed resulting in microstructural deterioration. The newly deposited bone is also less completely mineralized than the older bone resorbed. We examined whether breastfeeding, an estrogen deficient state, compromises bone microstructure and matrix mineral density. Distal tibial and distal radial microarchitecture were quantified using high-resolution peripheral quantitative computed tomography in 58 women prior, during and after breastfeeding, and in 48 controls during one to five years follow-up. Five months of exclusive breastfeeding increased cortical porosity by 0.6% (95% confidence interval [CI] 0.3-0.9), reduced matrix mineralization density by 0.26% (95% CI 0.12-0.41), (both p < 0.01), reduced trabecular number by 0.22 per mm (95% CI 0.15-0.28), and increased trabecular separation by 0.07 mm (95% CI 0.05-0.08), (all p < 0.001). Relative to pre-breastfeeding, at a median of 2.6 years (range 1 to 4.8) after cessation of breastfeeding, cortical porosity remained 0.58 SD (95% CI 0.48-0.68) higher, matrix mineralization density remained 1.28 SD (95% CI 1.07-1.49) lower, trabeculae were 1.33 SD (95% CI 1.15-1.50) fewer and 1.06 SD (95% CI 0.91-1.22) more greatly separated (all p < 0.001). All deficits were greater than in controls. The results were similar at distal radius. Bone microstructure may be irreversibly deteriorated following cessation of breastfeeding at appendicular sites. Studies are needed to establish whether this deterioration compromises bone strength and increases fracture risk later in life.
DOI: 10.1002/jbmr.3018
ORCID: 0000-0002-9692-048X
PubMed URL:
Type: Journal Article
Subjects: Cortical Porosity
Matrix Mineralization
Trabecular Bone Microarchitecture
Appears in Collections:Journal articles

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