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Area of Science:

  • Pediatric Cardiology
  • Pediatric Endocrinology
  • Bone Metabolism

Background:

  • Children with chronic diseases often exhibit low bone mineral density (BMD).
  • Limited research exists on BMD in pediatric patients with congenital heart disease, specifically single ventricle (SV) physiology.
  • Warfarin, a common treatment for SV, is suspected to negatively affect BMD in adults.

Purpose of the Study:

  • To assess BMD in pediatric patients with SV physiology.
  • To compare BMD between SV patients taking warfarin and those not on warfarin therapy.

Main Methods:

  • Dual-energy X-ray absorptiometry (DXA) was used to measure BMD z scores of the spine and total body less head (TBLH) in subjects aged 5-12 years.
  • Calcium intake, activity level, height, and Tanner stage were assessed.
  • Linear regression models and t tests were employed to analyze data and compare subgroups.

Main Results:

  • Mean spine BMD z score was significantly lower than expected (-1.0 ± 0.2, p < 0.0001), as was TBLH BMD z score (-0.8 ± 0.2, p < 0.0001).
  • These reductions remained significant after adjusting for height.
  • Patients on warfarin showed a trend towards lower BMD at both the spine and TBLH compared to non-warfarin users, though not statistically significant (p=0.106 and p=0.132, respectively).

Conclusions:

  • Pediatric patients with SV physiology exhibit significantly reduced BMD.
  • Warfarin may negatively impact BMD in this population, but further research is needed to confirm this effect.
  • Continued monitoring of bone density in children with SV and evaluation in other cardiac patients on warfarin are recommended.