Prolonged heparin therapy in pregnancy causes bone demineralization

The relation of heparin therapy to osteoporosis was assessed in a retrospective analysis of 20 women treated during and after pregnancy with subcutaneous heparin for thromboembolism prophylaxis. The phalangeal cortical area ratio was significantly less after long term therapy (greater than 25 weeks) compared with that after short term therapy (less than 7 weeks). The same trend was found in the metacarpal area ratio, although this did not reach statistical significance. The changes were most marked in a woman who had received heparin also in a previous pregnancy. No correlations were found between duration of therapy and back pain, conventional radiology of lumbar spine or the Singh index of femoral trabecular pattern which were within the normal range in all patients. The findings indicate a dose-related demineralization process associated with prophylactic heparin therapy in pregnancy. The correct methods of and criteria for thromboembolism prophylaxis in pregnancy need critical re-examination.