Background: Children with chronic diseases are at increased risk of secondary osteoporosis. In adults, long-term anticoagulation (LTA) including Vitamin K antagonist (VKA) treatment has been associated with an increased risk of osteoporosis and hip fractures. Risk factors of impaired skeletal health and the role of LTA on bone metabolism during the vulnerable phase of linear bone growth in children remain poorly understood.

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 BMD was decreased for both lumbar spine (-0.7SDS) and total body less head (TBLH; -1.32SDS). 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, intensity nor treatment duration were associated with BMD alterations. Interestingly, the undercarboxylated osteocalcin fraction was strongly correlated with patients’ age (R² 0.28; p<0.001) but not with BMD. Vitamin D deficiency was detected in 26% of patients with significantly lower values after onset of puberty (-34.5%; p=0.03).

Conclusions: 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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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/in-children-receiving-long-term-anticoagulation-decreased-bone-mineral-density-is-associated-with-pubertal-development/