This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Mary Fran Sowers, PhD; Bruce W. Hollis, PhD; Brahm Shapiro, MB, ChB, PhD; John Randolph, MD; Carol A. Janney, MS; Daowen Zhang, MS; M. Anthony Schork, PhD; Mary Crutchfield; Frank Stanczyk, PhD; Mary Russell-Aulet, MEd

JAMA. 1996;276(7):549-554.

Abstract
Objective.
—To investigate the hypothesis that parathyroid hormone—related peptide (PTHrP) may be involved with bone loss and recovery as a means of providing adequate calcium and phosphate to infants.

Design.
—An 18-month prospective cohort study.

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

Participants.
—Volunteer sample of 115 postpartum healthy women aged 20 to 40 years, and 0 or 1 parity prior to parturition with no intent to breast-feed or intent to breast-feed at least 6 months.

Main Outcome Measures.
—Parathyroid hormone-related peptide, prolactin, estradiol, 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D, femoral bone mineral density, and bone turnover markers were measured in 115 postpartum women at 2 weeks, 2 months, 4 months, 6 months, 12 months, and 18 months postpartum. Lumbar bone mineral density was measured at 2 weeks, 6 months, 12 months, and 18 months postpartum.

Results.
—Elevated PTHrP values were significantly associated (P<.001) with breast-feeding status, elevated prolactin levels, and lower serum estradiol levels, conditions occurring during lactation. Furthermore, elevated PTHrP levels were negatively and significantly associated (P<.01) over time with bone mineral density change at both the spine and the femoral neck, even after accounting for prolactin levels, breast-feeding status, return of menstruation, estradiol levels, PTH levels, 1,25-dihydroxyvitamin D levels, dietary calcium intake, physical activity, and body size.

Conclusion.
—These data clearly support the hypothesis that PTHrP is an alternative mechanism associated with bone loss and recovery during and subsequent to lactation.

Author Affiliations
From the Departments of Epidemiology (Dr Sowers, and Mss Crutchfield, and Russell-Aulet), Biostatistics (Dr Schork and Mss Janney and Zhang), Internal Medicine (Dr Shapiro), and Obstetrics and Gynecology (Drs Sowers and Randolph), University of Michigan, Ann Arbor; the Department of Pediatrics, Medical University of South Carolina, Charleston (Dr Hollis); and the Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles (Dr Stanczyk).

Footnotes
Reprints: Mary Fran Sowers, PhD, Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory, Room 3037, SPH-1, Ann Arbor, MI 48109-2029.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Parathyroid Hormone Contributes to Regulating Milk Calcium Content and Modulates Neonatal Bone Formation Cooperatively with Calcium
Cao et al.
Endocrinology 2009;150:561-569.
ABSTRACT | FULL TEXT  

Reproductive Hormones and Skeletal Health in Young Women
Ott
J. Clin. Endocrinol. Metab. 2008;93:1175-1177.
FULL TEXT  

Estrogen and the Death of Osteoclasts: A Fascinating Story
Khosla
IBMS BoneKEy 2007;4:267-272.
FULL TEXT  

Conversations Between Breast and Bone: Physiological Bone Loss During Lactation as Evolutionary Template for Osteolysis in Breast Cancer and Pathological Bone Loss After Menopause
Wysolmerski
IBMS BoneKEy 2007;4:209-225.
ABSTRACT | FULL TEXT  

Weaning Triggers a Decrease in Receptor Activator of Nuclear Factor-{kappa}B Ligand Expression, Widespread Osteoclast Apoptosis, and Rapid Recovery of Bone Mass after Lactation in Mice
Ardeshirpour et al.
Endocrinology 2007;148:3875-3886.
ABSTRACT | FULL TEXT  

Sex Hormone Binding Globulin: Inhibitor or Facilitator (or Both) of Sex Steroid Action?
Khosla
J. Clin. Endocrinol. Metab. 2006;91:4764-4766.
FULL TEXT  

Calcitonin Plays a Critical Role in Regulating Skeletal Mineral Metabolism during Lactation
Woodrow et al.
Endocrinology 2006;147:4010-4021.
ABSTRACT | FULL TEXT  

The effect of pregnancy and lactation on bone mineral density in fluoride-exposed rats
Yildiz and Oral
Toxicol Ind Health 2006;22:217-222.
ABSTRACT  

Medullary Thyroid Carcinoma Arises in the Absence of Prolactin Signaling
Kedzia et al.
Cancer Res. 2005;65:8497-8503.
ABSTRACT | FULL TEXT  

Weaning Initiates a Rapid and Powerful Anabolic Phase in the Rat Maternal Skeleton
Miller et al.
Biol. Reprod. 2005;73:156-162.
ABSTRACT | FULL TEXT  

Bone mass is recovered from lactation to postweaning in adolescent mothers with low calcium intakes
Bezerra et al.
Am. J. Clin. Nutr. 2004;80:1322-1326.
ABSTRACT | FULL TEXT  

Lactation Among Adolescent Mothers and Subsequent Bone Mineral Density
Chantry et al.
Arch Pediatr Adolesc Med 2004;158:650-656.
ABSTRACT | FULL TEXT  

Low Estrogen and High Parathyroid Hormone-Related Peptide Levels Contribute to Accelerated Bone Resorption and Bone Loss in Lactating Mice
VanHouten and Wysolmerski
Endocrinology 2003;144:5521-5529.
ABSTRACT | FULL TEXT  

Negative calcium balance during lactation in rural Mexican women
DeSantiago et al.
Am. J. Clin. Nutr. 2002;76:845-851.
ABSTRACT | FULL TEXT  

Cancellous and Cortical Bone Mechanical Properties and Tissue Dynamics During Pregnancy, Lactation, and Postlactation in the Rat
Vajda et al.
Biol. Reprod. 2001;65:689-695.
ABSTRACT | FULL TEXT  

Influence of Parity and Lactation on Hip Fracture Risk
Michaelsson et al.
Am J Epidemiol 2001;153:1166-1172.
ABSTRACT | FULL TEXT  

Calcium and Bone Metabolism in Pregnancy and Lactation
Kovacs
J. Clin. Endocrinol. Metab. 2001;86:2344-2348.
FULL TEXT  

The Physiology of Parathyroid Hormone-Related Protein
Strewler
NEJM 2000;342:177-185.
FULL TEXT  

Increased Intracortical Bone Remodeling During Lactation in Beagle Dogs
Vajda et al.
Biol. Reprod. 1999;61:1439-1444.
ABSTRACT | FULL TEXT  

Maintenance of Serum Calcium by Parathyroid Hormone-Related Peptide During Lactation in a Hypoparathyroid Patient
Mather et al.
J. Clin. Endocrinol. Metab. 1999;84:424-427.
ABSTRACT | FULL TEXT  

Effects of Calcium Supplementation on Calcium Homeostasis and Bone Turnover in Lactating Women
Kalkwarf et al.
J. Clin. Endocrinol. Metab. 1999;84:464-470.
ABSTRACT | FULL TEXT  

Osteoblasts Are a New Target for Prolactin: Analysis of Bone Formation in Prolactin Receptor Knockout Mice
Clément-Lacroix et al.
Endocrinology 1999;140:96-105.
ABSTRACT | FULL TEXT  

Changes in Bone Mass and Bone Biomarkers of Cynomolgus Monkeys during Pregnancy and Lactation
Lees et al.
J. Clin. Endocrinol. Metab. 1998;83:4298-4302.
ABSTRACT | FULL TEXT  

The Effects of Calcium Supplementation, Duration of Lactation, and Time of Day on Concentrations of Parathyroid Hormone-Related Protein in Human Milk: A Pilot Study
Cross et al.
J Hum Lact 1998;14:111-117.
ABSTRACT  

Biochemical Markers of Calcium and Bone Metabolism during 18 Months of Lactation in Gambian Women Accustomed to a Low Calcium Intake and in Those Consuming a Calcium Supplement
Prentice et al.
J. Clin. Endocrinol. Metab. 1998;83:1059-1066.
ABSTRACT | FULL TEXT  

Maternal-Fetal Calcium and Bone Metabolism During Pregnancy, Puerperium, and Lactation
Kovacs and Kronenberg
Endocr. Rev. 1997;18:832-872.
ABSTRACT | FULL TEXT  

The Effect of Calcium Supplementation on Bone Density during Lactation and after Weaning
Kalkwarf et al.
NEJM 1997;337:523-528.
ABSTRACT | FULL TEXT