title: A Cross-Sectional Study of Postpartum Changes in Bone Status in Indian Mothers.
abstract: BACKGROUND
  Bone turnover is high during lactation. However, studies on bone status of Indian urban mothers are scarce. Hence, the objective was to conduct a cross-sectional study on the lactation-related changes in bone health status of Indian mothers postpartum using Dual X-ray Absorptiometry (DXA) at 3 time points: within a week of delivery, at 1- and 3-years postpartum. We also explored the association of dietary calcium intake, physical activity, serum vitamin D status, and dietary traditional food supplements (Dietary Food supplements) with bone health.
  
  
  METHODS
  A cross-sectional study was conducted; 300 full-term, healthy primiparous women (28.6 ± 3.4 year) were randomly selected and categorized into 3 groups: 128 mothers within 7 days of delivery (Group A), 88 with 1-year-old children (B), and 84 with 3-year-old children (C). Anthropometry, lactation history, physical activity, diet, biochemical tests (vitamin D, parathyroid hormone), body composition, areal bone mineral density (a-BMD) at total body (TB), AP spine (APS), and dual neck femur (DF) were assessed by DXA (GE-Lunar DPX).
  
  
  RESULTS
  Significantly higher APS-BMD (mean ± SD) was observed in Group C (1.107 ± 0.098 g/cm(2)) than that in A (1.045 ± 0.131 g/cm(2)) (p < 0.05). When adjusted for breastfeeding practices, mean (±standard error) APS-BMD was lowest in women in Group A (1.024 ± 0.013 g/cm(2)), but was higher at 1-year (1.079 ± 0.02 g/cm(2)) and at 3-years postpartum (1.111 ± 0.019 g/cm(2)), though differences were significant only between groups A and C (p < 0.05). Most mothers from all 3 groups consumed inadequate amount of nutrients except dietary fat and showed low physical activity. Multiple regression analysis indicated that dietary calcium, moderate physical activity, serum vitamin D, and consumption of dietary food supplements were not significant predictors of APS-BMD (p > 0.1).
  
  
  CONCLUSIONS
  Prevalence of nutrient and vitamin D deficiencies, low physical activity, and poor sunlight exposure were major concerns in Indian lactating mothers; improvement in bone mass at APS was observed at 3-years which was most likely due to physiologic changes.
authors.affiliation: Growth and Endocrine Unit, Jehangir Hospital, Hirabai Cowasji Jehangir Medical Research Institute, 32, Sasoon Road, Pune, 411001 India.
authors.forename: Neha
authors.initials: N
authors.lastname: Kajale
authors.affiliation: Growth and Endocrine Unit, Jehangir Hospital, Hirabai Cowasji Jehangir Medical Research Institute, 32, Sasoon Road, Pune, 411001 India.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Khadilkar
authors.affiliation: Growth and Endocrine Unit, Jehangir Hospital, Hirabai Cowasji Jehangir Medical Research Institute, 32, Sasoon Road, Pune, 411001 India.
authors.forename: Shashi
authors.initials: S
authors.lastname: Chiplonkar
authors.affiliation: Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, M13 9WL UK.
authors.forename: Zulf
authors.initials: Z
authors.lastname: Mughal
authors.affiliation: Growth and Endocrine Unit, Jehangir Hospital, Hirabai Cowasji Jehangir Medical Research Institute, 32, Sasoon Road, Pune, 411001 India.
authors.forename: Vaman
authors.initials: V
authors.lastname: Khadilkar
authors.affiliation: Growth and Endocrine Unit, Jehangir Hospital, Hirabai Cowasji Jehangir Medical Research Institute, 32, Sasoon Road, Pune, 411001 India.
authors.forename: Nina
authors.initials: N
authors.lastname: Mansukhani
keywords: Body composition; Bone health; Indian mothers; Lactation; Postpartum