Heparin and pre-menopausal women: increased risk of osteopenia with prolonged use.

Clinical bottom line (level 4)

  1. Premenopausal women who took heparin for about half a year were at increased risk of osteopenia.
Ginsberg et al: Thrombosis and Haemostasis 1990; 64 (2): 286-289
Expires June 2003

The study

Case-control study with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Canada

122 patients (aged range 20 to 40 years; mean 30, 100% female) pre-menopausal women (56 pregnant)

Excluded if
  • on chronic corticosteroid therapy
  • marked obesity (>100 kg)
  • immobile >1 month
  • metastatic malignancy
  • thyrotoxic
  • hypogonadism
  • congenital disorders associated with osteopenia


    • Cases: 61 patients (100% female, mean age 30): on subcutaneous or intravenous heparin (mean dose 25,000 units per day for about 26 weeks)
    Controls: 61 patients (100% female, mean age 30): no heparin


    Outcomes studied:
  • osteopenia : spine <0.840 g/cm 3 or wrist <0.690 g/cm 3 , diagnosed using: dual photon densitometry of L2 to L4; single photon densitometry of wrist; lateral thoracolumbar film for silent crush fractures

    • The evidence

    Patient expected event rate for osteopenia: 7.75%
    risk factor osteopenia
    present    		 osteopenia
    absent    		 unadjusted OR
    (95% CI)    		 NNH
    (% CI)
    heparin 9 49 inf
    (3.6 to inf)
    no heparin 0 58

    • spine bone density g/cm ³ (SD):
      • control- 1.084 (0.126)
      • case- 1.047 (0.148)
      • mean difference (95% CI)- 0.037 (-0.012 to 0.086)
    • radius bone density g/cm ³ (SD):
      • control- 0.860 (0.086)
      • case- 0.863 (0.112)
      • mean difference (95% CI)- 0.003 (-0.038 to 0.032)

    Comments

    1. The study is too small to show any differences in bone density.

    Citation

    1. Ginsberg JS, Kowalchuk G, Hirsh J, et al: Heparin effect on bone density. Thrombosis and Haemostasis 1990; 64 (2): 286-289
    Contributor: Chris Ball and Clare Wotton, June 2000
    Reviewer:

    Clinical Question.
    Patient pre-menopausal women
    Intervention or Exposure heparin
    Outcome osteopenia