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.

Zusammenfassung

Einleitung Die Osteoporose ist die am häufigsten vorkommende metabolische Knochenerkrankung. Kennzeichnend für die Erkrankung ist eine niedrige Knochendichte. Es ist bekannt, dass verschiedene Reproduktionsfaktoren Auswirkungen auf die Knochenmineraldichte (KMD) haben können. Ein Kalziumverlust zulasten des mütterlichen Skeletts sowie ein Rückgang an KMD wurden besonders während der Schwangerschaft und Stillzeit beobachtet, obwohl manchen Studien zufolge dieser Verlust innerhalb von 6 – 12 Monaten wiedergutgemacht wird. Es gibt keinen Konsens darüber, ob die Auswirkungen von Reproduktionsfaktoren auf die Knochen positiv oder negativ sind. Die Adoleszenz stellt eine wichtige Phase für die Gesamtknochendichte dar, und die Gesamtknochendichte spielt eine wesentliche Rolle bei der Entwicklung einer Osteoporose. Das Ziel dieser Studie war es, zu untersuchen, ob das Alter der Mutter bei der Geburt des 1. Kindes, mehrfache Geburten während der Adoleszenz, der Abstand zwischen den Geburten und die Reproduktionsgeschichte (z. B. die Dauer der Stillzeit) sich auf die Knochenmineraldichte von postmenopausalen Frauen auswirkt.

Material und Methoden Die KMD wurde bei 196 postmenopausalen Patientinnen gemessen. Basierend auf diese Messergebnisse wurden die Frauen in 3 Gruppen eingeteilt: normale KMD, Osteopenie und Osteoporose. KMD-Messungen im Lenden- und Oberschenkelbereich und zur Feststellung der Gesamtknochendichte wurden mithilfe der dualen Röntgenabsorptiometrie (DXA) durchgeführt.

Ergebnisse Es gab keine statistisch signifikanten Unterschiede zwischen den Gruppen bezüglich der Gesamtdauer der Stillzeit (p = 0,596). Es stellte sich heraus, dass ein längerer Abstand zwischen Schwangerschaften das Risiko einer Osteoporose minderte. Bei Patientinnen mit Osteoporose betrug der durchschnittliche Abstand zwischen Schwangerschaften 1,4 ± 0,73 Jahre, während der durchschnittliche Abstand zwischen Schwangerschaften länger war bei Patientinnen mit Osteopenie (1,92 ± 1,20) bzw. bei Patientinnen mit normaler Knochendichte (2,45 ± 1,77) (p = 0,005). Obwohl das Alter der Mutter bei der Geburt ihres 1. Kindes statistisch gesehen keine Auswirkungen auf die KMD hatte, stellte sich in der univariaten logistischen Regressionsanalyse heraus, dass mehrere Geburten in der Adoleszenz das Risiko einer Osteoporose um das 6,833-Fache erhöhten (p = 0,001, OR: 6,833, 95%-KI: 2,131 – 21,908; p = 0,001). Ein späteres Alter beim Eintreten der Wechseljahre senkte das Risiko einer Osteoporose (OR: 0,911, 95%-KI: 0,843 – 0,985; p = 0,019).

Schlussfolgerung Häufige Geburten während des gebärfähigen Alters und mehr als 1 Kind während der Adoleszenz wirken sich negativ auf die Knochenmineraldichte bei postmenopausalen Frauen aus.

Key words

adolescent - breastfeeding - bone mineral density - postmenopausal osteoporosis - interpregnancy interval

Schlüsselwörter

Adoleszenz - Stillen - Knochenmineraldichte - postmenopausale Osteoporose - Abstand zwischen Schwangerschaften

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