Lefkou E, Khamashta M, Hampson G, Hunt B J
Guy's & St Thomas' NHS, London, UK.
Lupus. 2010 Jan;19(1):3-12. doi: 10.1177/0961203309353171. Epub 2009 Nov 24.
Long-term use of unfractioned heparin data has been associated with a 2.2-5% incidence of heparin-induced osteoporotic fracture, but for low-molecular-weight heparin (LMWH) data is scarce and there is lack of clarity of the risks of osteoporosis and osteoporotic fractures. In this paper we review the differential diagnosis of osteoporosis and osteoporotic fractures, and we conduct a systematic review of all related cases from case reports and trials. Two new cases of possible LMWH-induced osteoporosis are also presented and the difficulties in making the diagnosis are highlighted. The authors conclude that, until large clinical trials are designed to investigate pre- and post-treatment bone density and to compare different dosages of LMWH effect on the bone density in different patient groups, no safe conclusions can be made.
长期使用普通肝素的数据显示，肝素诱导的骨质疏松性骨折发生率为2.2% - 5%，但关于低分子量肝素（LMWH）的数据较少，且骨质疏松和骨质疏松性骨折的风险尚不清楚。在本文中，我们回顾了骨质疏松和骨质疏松性骨折的鉴别诊断，并对病例报告和试验中的所有相关病例进行了系统评价。还介绍了两例可能由低分子量肝素引起的骨质疏松新病例，并强调了诊断中的困难。作者得出结论，在设计大型临床试验以研究治疗前后的骨密度，并比较不同剂量的低分子量肝素对不同患者群体骨密度的影响之前，无法得出安全的结论。
