Megard M, Cuche M, Grapeloux A, Bojoly C, Meunier P J
Nouv Presse Med. 1982 Jan 30;11(4):261-4.
Following a 7-month treatment with heparin, a young pregnant woman with a history of multiple phlebites complicated by pulmonary infarction developed osteoporosis with multiple compression fractures of the vertebrae. Histomorphometric analysis of a transiliac bone biopsy showed severe osteoporosis with rarefaction of the spongy bone, considerable increase of osteoclasts and fall in osteoblasts. The cortex was not atrophic and was the seat of active reconstruction. Clinical and experimental data have shown that prolonged, high dosage heparin treatment may result in such osteopenias. Heparin acts synergistically with the parathyroid hormone to stimulate bone resorption, at the same time increasing bone collagen metabolism and modifying its structure. Clinical heparin osteoporosis, however, is rare, which suggests that other factors intervene. The risk of osteoporosis must be taken into account when heparin therapy is considered in pregnant women who are at high risk of thromboembolism.
一名有多次静脉炎病史并并发肺梗死的年轻孕妇，在接受肝素治疗7个月后，出现骨质疏松并伴有多个椎体压缩性骨折。对髂骨活检进行组织形态计量学分析显示，存在严重骨质疏松，松质骨稀疏，破骨细胞显著增多，成骨细胞减少。皮质未萎缩，是活跃重建的部位。临床和实验数据表明，长期、高剂量的肝素治疗可能导致此类骨质减少。肝素与甲状旁腺激素协同作用，刺激骨吸收，同时增加骨胶原代谢并改变其结构。然而，临床肝素诱导的骨质疏松很少见，这表明有其他因素介入。对于有血栓栓塞高风险的孕妇，在考虑肝素治疗时，必须考虑骨质疏松的风险。
