INVESTIGATING THE EFFECTS OF CALCIUM AND CALCIFEROL AUGMENTATION ON OSTEO-MINERAL IMPENETRABILITY DURING EARLY BREASTFEEDING

Main Article Content

Huba Khalid
Muhammad Imran Hussain
Fatima Naveed
Ruhab Zulfiqar
Eman
Saima
Moha Akram Khan
Samia Anwar
Nida Zahid
Farah Qaisar
Tashfeen bin Asif
Khansa
Sania Khalid

Keywords

Lactation, Breastfeeding, Calcium, Vitamin D3, BMD T and Z scores.

Abstract

Lactation is a physiological process of milk secretion that involves many physiological factors that possess strong potential to influence bone mineral density (BMD) which is the best tool to analyze the fracture rate in later life. This study investigates the combined effect of Vitamin D and Calcium supplementation on lactation and maternal BMD. This is randomized controlled trial study. The study involved 60 patients (lactating mothers) divided into a treatment group. They were divided into treatment group (Calcium (1000mg) and Vitamin D (400IU) supplementation) and a control group (placebo) comprising thirty patients per group. The mean age in control group and treatment group is 32± 6.5 and 32±6.3years respectively. Statistical analysis revealed that the treatment group had a mean serum calcium level of 10.12±0.429 (P<0.001), serum vitamin D3 level 13.30±2.23 (P=0.003), BMD T score -2.32±0.376 (P=0.03), and Z score -2.55±0.40 (P=0.028). These results showed statistically significant effect of vitamin D and calcium supplement on serum calcium and 25-hydroxy vitamin D level which substantially increased the BMD values (T-scores) (Z-scores) for patients in the treatment group. Combined supplementation of calcium and vitamin D improved the BMD during early lactation which can delay osteoporosis and osteopenia.

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References

1. Miyamoto T, Miyakoshi K, Sato Y, Kasuga Y, Ikenoue S, Miyamoto K, Nishiwaki Y, Tanaka M, Nakamura M, Matsumoto M. Changes in bone metabolic profile associated with pregnancy or lactation. Scientific reports. 2019 May 13;9(1):6787.
2. Hussain, M. I., Ahmed, W., Nasir, M., Mushtaq, M. H., Sheikh, A. A., Shaheen, A. Y., Ali, S., & Iqbal, S. (2019). Immune modulatory and anti-oxidative effect of selenium against pulmonary tuberculosis. Pakistan journal of pharmaceutical sciences, 32(2 (Supplementary)), 779–784. 13.
3. Hussain, M. I., Ahmed, W., Nasir, M., Mushtaq, M. H., Sheikh, A. A., Shaheen, A. Y., & Mahmood, A. (2019). Immune boosting role of vitamin E against pulmonary tuberculosis. Pakistan journal of pharmaceutical sciences, 32(1(Supplementary)), 269–276
4. Tariq S, Baig M, Tariq S, Shahzad M. Status of bone health and association of socio-demographic characteristics with Bone Mineral Density in Pakistani Females. Pakistan Journal of Medical Sciences. 2019 May;35(3):812.
5. Zarattini G, Buffoli P, Isabelli G, Marchese M. Pregnancy-associated osteoporosis with seven vertebral compression fractures, a case treated with strontium ranelate. Clinical Cases in Mineral and Bone Metabolism. 2014 May;11(2):139.
6. Elliott-Sale KJ. Pregnancy, Sex Hormones, and Exercise. InSex Hormones, Exercise and Women: Scientific and Clinical Aspects 2023 Jun 6 (pp. 327-349). Cham: Springer International Publishing.
7. Yao D, Huang L, Ke J, Zhang M, Xiao Q, Zhu X. Bone metabolism regulation: Implications for the treatment of bone diseases. Biomedicine & Pharmacotherapy. 2020 Sep 1;129:110494.
8. Prentice A. Maternal calcium requirements during pregnancy and lactation. The American journal of clinical nutrition. 1994 Feb 1;59(2):477S-83S.
9. Del Valle HB, Yaktine AL, Taylor CL, Ross AC, editors. Dietary reference intakes for calcium and vitamin D.
10. Memon AG, Latif FA, Sanaullah M, Hussain MI, Irum S, Rehman FU. Prevalence of lateral epicondylitis among restaurant chefs with low level of serum Vitamin D. Rawal Medical Journal. 2023 May 31;48(2):422-.
11. Hussain MI, Ibtisam R, Fatima T, et al. The role of vitamin D supplementation in augmenting IFN-γ production in response to mycobacterium tuberculosis Infection: A randomized controlled trial. Pak J Pharm Sci. 2023;36(6(Special)):1901-1908.
12. Kovacs CS. Maternal mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery. Physiological reviews. 2016 Feb 17.
13. Svejme O, Ahlborg HG, Nilsson JÅ, Karlsson MK. Low BMD is an independent predictor of fracture and early menopause of mortality in post-menopausal women–a 34-year prospective study. Maturitas. 2013 Apr 1;74(4):341-5.
14. Hansen MA, Overgaard K, Riis BJ, Christiansen C. Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study. British medical journal. 1991 Oct 19;303(6808):961-4.
15. Kovacs CS. Vitamin D in pregnancy and lactation: maternal, fetal, and neonatal outcomes from human and animal studies. The American journal of clinical nutrition. 2008 Aug 1;88(2):520S-8S.
16. Al-Janabi AA. The influence of age, menstrual state and body mass index on the relation between osteopenia and osteoporosis associated with breast cancer. Journal of Obstetrics and Gynaecology. 2022 Oct 3;42(7):3368-73.
17. Ha JH, Kim HS, Won SJ, Lee YK, Koo KH. Physicians’ Attitudes on Management of Osteopenia in South Korea. Journal of bone metabolism. 2020 Aug;27(3):201.
18. Nakamura Y, Kamimura M, Ikegami S, Mukaiyama K, Komatsu M, Uchiyama S, Kato H. A case series of pregnancy-and lactation-associated osteoporosis and a review of the literature. Therapeutics and clinical risk management. 2015 Sep 7:1361-5.
19. Cheesbrough M. District Laboratory Practice in Tropical Countries. IJMS. 2018 Jan;1(1):65-8.
20. Lampropoulou-Adamidou K, Karlafti E, Argyrou C, Makris K, Trovas G, Dontas IA, Tournis S, Triantafyllopoulos IK. Effect of calcium and vitamin D supplementation with and without collagen peptides on volumetric and areal bone mineral density, bone geometry and bone turnover in postmenopausal women with osteopenia. Journal of Clinical Densitometry. 2022 Jul 1;25(3):357-72.
21. Cerit ET, Cerit M. A case of pregnancy and lactation associated osteoporosis in the third pregnancy; robust response to teriparatide despite delayed administration. Bone Reports. 2020 Dec 1;13:100706.
22. Jadhav A, Jadhav S, Varma A. Pregnancy-and Lactation-Associated Osteoporotic Vertebral Fracture: A Case Report. Cureus. 2022 Nov 10;14(11).
23. LeBoff MS, Greenspan SL, Insogna KL, Lewiecki EM, Saag KG, Singer AJ, Siris ES. The clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis international. 2022 Oct;33(10):2049-102.
24. Berry SD, Kiel DP, Colón-Emeric C. Hip fractures in older adults in 2019. Jama. 2019 Jun 11;321(22):2231-2.
25. Polat SB, Evranos B, Aydin C, Cuhaci N, Ersoy R, Cakir B. Effective treatment of severe pregnancy and lactation-related osteoporosis with teriparatide: case report and review of the literature. Gynecological Endocrinology. 2015 Jul 3;31(7):522-5.

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