An Evaluation of the Association of Reproductive History and Multiple Births during Adolescence with Postmenopausal Osteoporosis

Abstract

Introduction Osteoporosis is the most common metabolic bone disease characterized by low bone mass. Reproductive factors are known to affect bone mineral density (BMD). Calcium loss from maternal bone and decreased BMD have been observed especially during pregnancy and lactation, although this loss has been reported to recover within 6 – 12 months. There is no consensus on whether the effect of reproductive factors on the bone is positive or negative. The adolescent period is important for total bone mass, and total bone mass is significant in osteoporosis. The aim of this study was to investigate the effect of first gestational age, multiple births during adolescence, interpregnancy interval and reproductive history such as duration of breastfeeding on bone mineral density in postmenopausal women. Materials and Methods BMD was measured in a total of 196 postmenopausal patients and in accordance with the results, analysis was made of three groups as normal, osteopenia and osteoporosis. Dual Energy X-Ray Absorptiometry (DEXA) was used to take the lumbar, femoral and total bone BMD measurements. Results No statistically significant difference was determined between the groups in respect of total breastfeeding time (p = 0.596). It was detected that an increased interpregnancy interval decreased the risk of osteoporosis. In patients with osteoporosis, the mean interpregnancy interval was 1.4 ± 0.73 years, while it was longer in patients with osteopenia (1.92 ± 1.20) and normal BMD (2.45 ± 1.77) (p = 0.005). While no effect was determined of the first gestational age on BMD, in the univariate logistic regression analysis, multiple births in the adolescent period were seen to increase the risk of osteoporosis 6.833-fold (p = 0.001, OR = 6.833, 95% CI = 2.131 – 21.908; p = 0.001). The increase in the age of menopause was determined to decrease the risk of osteoporosis (OR = 0.911, 95% CI = 0.843 – 0.985; p = 0.019). Conclusion Having frequent births throughout the whole reproductive age and having more than one child in adolescence has an adverse effect on postmenopausal bone mineral densities.

Association of breastfeeding and postmenopausal osteoporosis in Chinese women: a community-based retrospective study

“…In the study of Sri Lanka, prolonged breastfeeding had no detrimental effect on BMD in postmenopausal women [21]. Similarly, in a latest study in Turkey, no statistically significantly difference was examined among the groups (normal, osteopenia, and osteoporosis) in respect of total breastfeeding time, but whether breastfeeding was a risk factor for osteoporosis compared to other types of feeding was not involved [17]. These discrepancies above may have been due to the differences in study design and study population.…”

“…During the breastfeeding, the estrogen level increased, which may keep the balance between bone resorption and formation [5, 12]. Some researchers considered that the ovarian with low activity may contribute to the contraceptive effect of breastfeeding [17]. Actually, the pregnancy interval and the number of pregnancy are independent factors for bone recovery instead of breastfeeding [9].…”

“…Some studies suggested that the history of breastfeeding can significantly increased the risk of PMOP [13], while some studies showed that prolonged breastfeeding duration was an independent risk factor for the development of PMOP rather than breastfeeding itself [14, 15]. Conversely, some studies suggested that the history of breastfeeding may increase the bone mass density, which significantly decreased the incidence of PMOP [16], whereas other studies demonstrated a non-significant relationship between breast-feeding and PMOP [9, 17].…”

Does adolescent pregnancy affect postmenopausal bone mineral density?

“…Patients with a history of AP had a mean body mass index (BMI) of 30.34±6.08 kg/m2, and those without a history of AP had a mean BMI of 31.35±6.25 kg/m2 respectively. Patients having a history of AP and those without a history of AP had median parities of 5 [4][5][6] and 3 [1][2][3][4][5], respectively. The median [25%-75%] gravida of patients with a history of AP and without a history of AP were 5 [4][5][6] and 3 [1][2][3][4][5], respectively.…”

“…In addition, there are studies stating that pregnancy and breastfeeding during adolescence may cause a decrease in postmenopausal bone mass (3). There is physiologically increased bone turnover and calcium release during pregnancy (4).…”