ESPE2021 ePoster Category 1 Bone B (10 abstracts)
Decreased bone mineral density in children receiving long-term anticoagulation is associated with pubertal development
Adalbert Raimann 1,2 , Janina Patsch 1 , Michael Weber 1 , Florentina Haufler 1 , Christiane Pees 1 , Sulaima Albinni 1 , Christoph Male 1 , Gabriele Haeusler 1,2 & Katharina Thom 1
1Medical University of Vienna, Vienna, Austria; 2Vienna Bone and Growth Center, Vienna, Austria
Background: Children and adolescents with chronic conditions are at increased risk of secondary osteoporosis. In adult patients, long-term anticoagulation (LTA) including Vitamin K antagonist (VKA) treatment is associated with lower bone mineral density and hip fractures. In children and adolsescent, risk factors for impaired skeletal health and the role of LTA on bone metabolism during the vulnerable phase of linear bone growth remain poorly defined.
Aims: To assess bone mineral density (BMD) and to identify risk factors for decreased BMD in children with chronic diseases receiving LTA.
Methods: Children under LTA were included in a cross-sectional approach to assess age, height and sex-adjusted BMD on a Hologic QDR 4500. Further investigations included anthropometric and biochemical markers for skeletal metabolism, and carboxylation-specific osteocalcin as marker for Vitamin K status.
Results: 39 children (age 4-18 years) were included, 31 (79%) on VKA and 8 (21%) on direct oral anticoagulants. Mean body length below average (-0.56SDS), BMI was Mean BMD was decreased for both lumbar spine (-0.7SDS) and total body less head (TBLH; -1.32SDS). 9 patients (23%) had a history of fractures. Earlier pubertal stages were strongly associated with decreased BMD-TBLH (-1.9SDS; P = 0.01). Additionally, low body mass index (BMI) correlated significantly with reduced BMD (R² 0.24; P = 0.003). Neither LTA type, treatment intensity nor treatment duration were associated with BMD alterations. Interestingly, the undercarboxylated osteocalcin fraction strongly correlated with patients’ age (R² 0.28; P < 0.001) but neither with BMD, duration or intesity of LTA. Vitamin D deficiency was detected in 26% of patients with significantly lower values after onset of puberty (-34.5%; P = 0.03).
Conclusion: In children with chronic diseases under LTA we found substantially reduced BMD. While type of anticoagulation was not associated with BMD, low BMI and delayed progression of puberty represent important risk factors for decreased BMD in children. Awareness of potential modifiers of BMD and high rates of Vitamin D deficiency in pubertal patients could contribute to improve bone health in this vulnerable patient group.
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