哺乳期母体的矿物与骨代谢改变

Maternal mineral and bone metabolism during lactation

完全母乳喂养的妇女平均每日从乳汁中丢失200~250 mg钙,最多可达400 mg。在哺乳期,母体的矿物离子以及钙调激素都发生了变化,主要的适应性改变包括骨吸收以及肾钙重吸收增加,其中以骨吸收增加为主。大多数情况下,哺乳所致的生理性骨量减少不引起临床症状,哺乳停止后,降低的骨量可得到恢复。但在妊娠前即存在低骨量等危险因素的妇女中,可发生哺乳期骨质疏松,甚至骨质疏松性骨折。目前对于哺乳期骨质疏松以及骨质疏松性骨折的治疗尚无定论,而且哺乳对于骨骼的长期影响目前也仍有争议。因此,本文就目前对哺乳期妇女的矿物以及骨代谢改变做一综述,以更好地预防和治疗哺乳所致的骨量严重减少。

Nursing mothers provide their infants with an average of 200-250mg of Ca/d, and as much as 400 mg/d. During lactation, maternal mineral ions and calciotropic hormones experience great changes. The main adaptations include increased skeletal resorption and reduced renal excretion of calcium, while the increased skeletal resorption plays a major role. In most cases, the physiological bone loss caused by breast-feeding does not cause clinical symptoms, which can be recovered completely after breast-feeding stopped. But among women with risk factors such as low bone mass before pregnancy, osteoporosis can occur during lactation and even to osteoporotic fractures. However, at present, there is still no definite conclusion for the treatment of osteoporosis and osteoporotic fracture related to lactation. The long-term effects of lactation on bone are still controversial. This article reviews the changes in the mineral and bone metabolism of women in lactation, so as to better understand and prevent the severe bone loss caused by breast-feeding.