Bone density changes in women who receive thromboprophylaxis in pregnancy

Objective The purpose of this study was to compare unfractionated heparin therapy to the low molecular weight heparin, enoxaparin sodium, and their effects on bone mineral density over the course of pregnancy. Study design Pregnant patients whose condition required thromboprophylaxis were recruited in this prospective randomized controlled trial and were assigned to receive either unfractionated heparin therapy or low molecular weight heparin therapy. Bone mineral density was measured by dual energy x-ray absorptiometry at the proximal femur on enrollment and again shortly after delivery. Results One hundred twenty women were enrolled, and 98 women completed the study. There was no difference in the change in bone mineral density at the femoral neck (P = .054) or total proximal femur (P = .584) between groups. Only 1 of 40 patients (2.5%) who received unfractionated heparin therapy and 1 of 49 patients (2.0%) who received low molecular weight heparin therapy (P = 1.0) experienced bone loss of ≥10% at the femoral neck. Conclusion In this study, the incidence of clinically significant bone loss (≥10%) in the femur in women who received thromboprophylaxis in pregnancy is approximately 2% to 2.5% and appears to be similar, regardless of whether the patient receives low molecular weight heparin therapy or unfractionated heparin therapy.