Le Templier Genevieve, Rodger Marc A
Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Canada.
Curr Opin Pulm Med. 2008 Sep;14(5):403-7. doi: 10.1097/MCP.0b013e3283061191.
Osteoporosis is the most common serious side effect of long-term unfractionated heparin use. Until recently, it was unknown whether long-term low-molecular-weight heparin was associated with any change in bone mineral density. With increasing long-term low-molecular-weight heparin use, for a variety of indications, this was an important knowledge gap.
We recently completed an a-priori planned substudy to assess the effect of low-molecular-weight heparin on bone mineral density in an ongoing multicenter multinational randomized trial designed to compare the effect of low-molecular-weight heparin prophylaxis on pregnancy outcomes in thrombophilic pregnant women. The results revealed that there is no significant difference in mean bone mineral density between a low-molecular-weight heparin prophylaxis group and a no prophylaxis group. The study was not adequately powered to detect differences in absolute fracture risk.
Recent results suggest that the use of long-term prophylactic low-molecular-weight heparin in pregnancy is not associated with a significant decrease in bone mineral density. Whether higher doses might be a risk factor for osteoporosis is still an unanswered question. It is also possible that subgroups are more susceptible. Overall, women should be reassured regarding the risk of osteoporosis associated with the use of prophylactic dose of low-molecular-weight heparin during their pregnancy.
骨质疏松是长期使用普通肝素最常见的严重副作用。直到最近，长期使用低分子肝素是否会导致骨密度变化仍不明确。随着低分子肝素在各种适应症下的长期使用日益增多，这是一个重要的知识空白。
我们最近完成了一项预先计划的子研究，以评估低分子肝素对骨密度的影响，该研究是一项正在进行的多中心跨国随机试验的一部分，旨在比较低分子肝素预防对血栓形成倾向孕妇妊娠结局的影响。结果显示，低分子肝素预防组和无预防组之间的平均骨密度没有显著差异。该研究没有足够的效力来检测绝对骨折风险的差异。
近期结果表明，孕期长期预防性使用低分子肝素与骨密度显著降低无关。更高剂量是否为骨质疏松的危险因素仍是一个未解决的问题。也有可能某些亚组更易受影响。总体而言，应让女性放心，孕期使用预防性剂量低分子肝素与骨质疏松风险无关。
