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MaryFran Sowers, PhD; Genie Corton; Brahm Shapiro, MD; Mary L. Jannausch, MS; Mary Crutchfield; Mindy L. Smith, MD; John F. Randolph, MD; Bruce Hollis, PhD

JAMA. 1993;269(24):3130-3135.

Abstract
Objective.
—To test the a priori hypotheses that significant bone loss occurs in lactation of greater than 5 months' duration and that bone mass returns to baseline levels when breast-feeding ceases.

Design.
—Prospective cohort study design of 12 months' duration.

Setting.
—General community setting with recruitment occurring at birthing education classes.

Participants.
—Volunteer sample of 98 healthy women of white (n=95) and Asian (n=3) origin, aged 20 to 40 years, and 0 to 1 parity prior to parturition, grouped according to lactation duration: 0 through 1, 2 through 5, and 6 or more months.

Main Outcome Measures.
—Bone mineral density (BMD) of the proximal femur was measured by dual-energy x-ray densitometry at 2 weeks (baseline), 2 months, 4 months, 6 months, and 12 months following parturition, and BMD of the lumbar spine was measured at baseline, 6 months, and 12 months after parturition.

Results.
—Women with lactation duration of 6 months or longer had mean BMD losses of 5.1% and 4.8% at the lumbar spine and femoral neck, respectively, comparing baseline values with those at 6 months post partum. Women who breast-fed 0 through 1 month lost no BMD at either bone site. Bone loss in women who breast-fed 6 months or longer was not explained by differences in age, diet, body size, or physical activity. Among women who breast-fed 6 months or longer, there was evidence of return to baseline levels of the lumbar spine at 12 months after parturition. The BMD of the lumbar spine of those women who continued to breast-feed more than 9 months had increased but was still significantly lower than baseline.

Conclusion.
—Extended lactation (70% of energy intake is provided for 6 months) is associated with bone loss; however, there is evidence of return to baseline BMD measurement at 12 months after parturition.

(JAMA. 1993;269:3130-3135)

Author Affiliations
From the Departments of Epidemiology (Dr Sowers and Mss Corton, Jannausch, and Crutchfield), Internal Medicine (Dr Shapiro), Family Practice (Dr Smith), and Obstetrics and Gynecology (Dr Randolph), University of Michigan, Ann Arbor; and the Department of Neonatology, Medical College of South Carolina, Charleston (Dr Hollis).

Footnotes
Reprint requests to Department of Epidemiology, University of Michigan, 109 Observatory St, Ann Arbor, MI 48109-2029 (Dr Sowers).

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