Minimising the risk of heparin-induced osteoporosis during pregnancy

Unfractionated heparin (UFH) may lead to symptomatic vertebral fractures in up to 3 out of every 100 people on long-term therapy. Ten-times that many people will experience a significant reduction in bone density leading to osteopoenia or osteoporosis. Low molecular weight heparins (LMWH) have been shown to be as effective as UFH in the prevention and treatment of venous thromboembolism. Several well-established advantages of LMWH over UFH include increased bioavailability, more predictable dose response, less intensive coagulation monitoring, and a lower probability of causing immune-mediated thrombocytopenia. There is also some evidence that long-term LMWH therapy is less likely to cause osteoporotic fractures and significant reductions in bone mass than UFH. Both UFH and LMWH undergo pharmacokinetic changes during pregnancy, which sometimes necessitates dosage adjustments. Fondaparinux is a synthetic antithrombotic agent, which specifically binds to antithrombin. It has been shown to be comparable to, or even more effective than, LMWH in the management of both arterial and venous thrombosis. Fondaparinux does not appear to have a negative effect on bone metabolism. Therefore, fondaparinux may be a safe and effective alternative to UFH and LMWH in women who require anticoagulation during pregnancy.