Bone mineral changes during pregnancy and lactation

Significant calcium transfer from the mother to the fetus and infant occurs during pregnancy and lactation, theoretically placing the mother at an increased risk for osteoporosis later in life. During pregnancy, intestinal calcium absorption increases to meet much of the fetal calcium needs. Maternal bone loss also may occur in the last months of pregnancy, a time when the fetal skeleton is rapidly mineralizing. The calcium needed for breast milk production is met through renal calcium conservation and, to a greater extent, by mobilization of calcium from the maternal skeleton. Women experience a transient loss of approx 3-7% of their bone density during lactation, which is rapidly regained after weaning. The rate and extent of recovery are influenced by the duration of lactation and postpartum amenorrhea and differ by skeletal site. Additional calcium intake does not prevent bone loss during lactation or enhance the recovery after weaning. The recovery of bone is complete for most women and occurs even with shortly spaced pregnancies. Epidemiologic studies have found that pregnancy and lactation are not associated with an increased risk of osteoporotic fractures.