This systematic review and meta-analysis examined the association between postpartum lactation and changes in bone mineral density (BMD) in adults, with the goal of informing evidence-based physical activity and return-to-exercise guidelines. Fourteen prospective, longitudinal cohort studies were included, each assessing BMD via dual-energy x-ray absorptiometry (DEXA) at early postpartum, during peak lactation, and after weaning. Studies followed participants for a minimum of six months postpartum and focused on clinically relevant skeletal sites, including the lumbar spine, femoral neck, and whole body.
Across all included studies, lactation was consistently associated with a measurable but temporary reduction in raw BMD at the lumbar spine, femoral neck, and whole body during peak lactation. Importantly, pooled findings demonstrated that BMD generally recovered to near early postpartum baseline levels by the weaning or post-lactation phase, typically within 18 months postpartum. However, longer durations of lactation were associated with greater magnitude of BMD loss and a prolonged recovery timeline, particularly at the femur and lumbar spine, regions critical for load-bearing and athletic activity.
These findings reinforce that lactation-related bone loss represents a physiological and reversible adaptation rather than a permanent deficit in healthy adults. Nevertheless, the transient nature of reduced BMD has important clinical implications for postpartum exercise prescription, injury risk, and return-to-sport decision making. The authors emphasize the need for future research to integrate lactation duration and skeletal recovery timelines into postpartum physical activity guidelines, particularly for individuals engaging in higher-impact or high-load activities.
Kosbab, E., Christopher, S., Horn, M. E., Tally, Z., Adams, V., Ledbetter, L., ... & Pietrosimone, L. (2025). Changes in Bone Mineral Density in Postpartum People During Lactation: A Systematic Review and Meta-Analysis. Journal of Athletic Training, 1(aop).
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