I have heard that there is a correlation between breast-feeding and osteoporosis. At the age of 42, I am pregnant for the first time and would like to breast-feed my baby, but I have a strong family history of osteoporosis and I am afraid to do so. What is your opinion?

Osteoporosis literally means "porous bone" or "bones with tiny holes."

Due to the loss of bone density, the risk of fracture from trivial accidents is increased. The precise cause of osteoporosis is unknown; estrogen deficiency is acknowledged as a major cause of postmenopausal osteoporosis, and many studies show that inactivity and calcium deficiency are some precipitating factors.

Many endocrine conditions—from hyperthyroidism (overactive thyroid), to Cushing syndrome (overactive secretions of the adrenal gland), and hyperparathyroidism (overactive parathyroid glands), and steroids, thyroid hormones, anticonvulsives, anticoagulants, antacids that contains aluminum, some diuretics, eating disorders, cigarette smoking and alcohol abuse, and Tamoxifen (premenopausal use)—all contribute to bone loss and may be related to the development of osteoporosis.

Other factors include having ancestors that came from Europe, especially Northern Europe; being thin, tall, and having a low fat mass (weight less than 127 lbs); a family history of osteoporosis; a history of breakage of a bone, and either complete or incomplete breakage of the hip, vertebra, and/or distal forearm after age 40; and/or a maternal or paternal history of hip, wrist, or spine fractures after age 50.

Perimenopausal women who lack menstrual periods, including those with low estrogen, marathon runners, gymnasts, and athletes, are also at risk of developing osteoporosis.

It is best to diagnose osteoporosis in its early stages, before bone fractures occur. To determine this, a bone mineral density (BMD) test is required. Bone mineral density is a simple, painless method to diagnose osteoporosis. This test determines the thickness of the bone, using a small amount of radiation or ultrasound. It only takes a few minutes, with one-tenth the radiation of a standard chest x-ray.

The BMD test is not recommended for healthy perimenopausal women.

Screening should be reserved for high-risk perimenopausal women and should be ordered only if the result is going to influence a decision.

Women at high risk are those with an x-ray suggestive of osteopenia, women receiving long-term steroid therapy, those with a history of eating disorders such as anorexia nervosa, and women diagnosed with primary asymptomatic hyperparathyroidism.

One recent study measured the bone density of women who were committed to breast-feeding their newborn for six months.

A group of 135 breast-fed their baby without receiving calcium supplementation, 139 received calcium supplementation.

There was a third control group of 153 women who had recently given birth but were not lactating. Their BMD from the radius and spine bone were measured immediately postpartum and 3, 6, 12 and 18 months after delivery.

There was a significant bone decrease in those who were breast-feeding for up to six months with improvements thereafter. After 18 months, the bone mineral density in all three groups were improved from early post-partum.

You do not have to worry about increasing your risk of osteoporosis by breast-feeding. And there are great benefits associated with breast feeding. Breast milk is the best form of nutrition for the newborn — there is no substitute.

I strongly recommend that every baby be breast-fed during the first six months. It's convenient: no bottle to warm up or wash, and above all, it's "free." Children who have been breast-fed are less likely to suffer from infectious diseases, have less serious infections, fewer hospitalizations, and experience improved motor and mental development.

An intense mother-infant bonding occurs during breast-feeding. Women who breast-feed their babies have a reduced risk of ovarian and pre-menopausal breast cancer, osteoporosis, and hip fractures, and loose less blood after childbirth. Fortunately, our society has become more open to women breast-feeding in public.

Immediately after, or within a few hours of birth, your baby will be placed on your breast to learn to suck. Suckling is necessary in order to initiate your milk production.

Consider enrolling in a breast-feeding class before your baby is born. While breast-feeding, you should continue with your prenatal vitamins, drink plenty of fluids, and eat a calcium-rich diet. Additionally, you may wish to consider calcium supplements.

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