Bone density changes in pregnant women treated with heparin: a prospective, longitudinal study.
Heparin plus aspirin significantly improves the live birth rate of women with primary antiphospholipid syndrome. Osteopenia is a major concern of long-term heparin therapy. We studied prospectively the bone mineral density (BMD) changes during pregnancy and the puerperium in 123 women with primary antiphospholipid syndrome treated with low-dose aspirin and subcutaneous low-dose heparin (46 women took unfractionated heparin and 77 took low-molecular-weight heparin). Lumbar spine, neck of femur and forearm BMD were measured, using dual energy X-ray absorptiometry, at 12 weeks gestation, immediately postpartum and 12 weeks postpartum. The mean heparin duration was 27 weeks (range 22-29). During pregnancy, BMD decreased by 3.7% (P < 0.001) at the lumbar spine and by 0.9% (P < 0.05) at the neck of femur with no significant change at the forearm. Lactation was associated with a significant decrease in the lumbar spine and neck of femur BMD. There was no significant difference in BMD changes between the two heparin preparations. No woman suffered a symptomatic fracture. Long-term heparin treatment during pregnancy is associated with a small but significant decrease in BMD at the lumbar spine and neck of femur. This decrease is similar to that previously reported to occur in untreated pregnancies.
Backos
M
M
Departments of Obstetrics & Gynaecology, ICSM at St Mary's and Hammersmith Hospital, Praed Street, London W2 1PG, UK.
Rai
R
R
Thomas
E
E
Murphy
M
M
Doré
C
C
Regan
L
L
D015502:Absorptiometry, Photon; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000188:drug therapy; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000139:chemically induced; D005260:Female; D005272:Femur Neck; D005542:Forearm; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007774:Lactation; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications; D011446:Prospective Studies
D006493:Heparin; D001241:Aspirin