Reduced bone density in children on long-term warfarin

Area of Science:

• Pediatric Endocrinology
• Pharmacology
• Bone Metabolism

Background:

• Vitamin K is crucial for bone density development in children and preventing osteoporosis later in life.
• Warfarin, a vitamin K antagonist, is increasingly prescribed for pediatric patients.
• The long-term impact of warfarin on pediatric bone density remains largely unknown.

Purpose of the Study:

• To investigate the long-term effects of warfarin on bone mineral density in children.
• To compare bone density in children using long-term warfarin with a control group.

Main Methods:

• A case-control study surveyed bone density in children on long-term warfarin (n=17) versus controls (n=321).
• Bone mineral apparent density (BMAD) and areal bone mineral density Z-scores of the lumbar spine were measured.
• Statistical analysis included adjustments for age and body size.

Main Results:

• Children on long-term warfarin exhibited a significant reduction in lumbar spine bone mineral apparent density (0.10 g/cm3 vs 0.12 g/cm3, p<0.001).
• Lumbar spine areal bone mineral density Z-scores were also significantly lower in the warfarin group (-1.96 vs controls).
• These differences persisted after adjusting for age and body size.

Conclusions:

• Long-term warfarin use in children is associated with significantly reduced bone density.
• The etiology of reduced bone density in these patients is likely multifactorial.
• Routine screening for reduced bone density should be considered in children receiving long-term warfarin therapy.