THU0500 Effects of long-term use of unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) on bone mineral density (BMD) in patients with nephrotic syndrome
Authors: S.V. Monov, D. Monova, R. Shumnalieva
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Osteoporosis is a systemic skeletal disease characterised by decreased bone mass and micro- and macroarchitectural tissue alterations, resulting in bone fragility and increased fracture risk. Generalised osteoporosis is a result of different causes and pathogenic mechanisms, which often combine forces to become clinically relevant. Among the different exogenic factors, several drugs have been associated with increased risk of osteoporosis, when used chronically. <h3>Objectives</h3> The aim of this study is to determine the effects of UFH or LMWH therapy of at least 1 year duration on bone mineral density BMD in patients with nephrotic syndrome (NS). <h3>Methods</h3> All patients undergoing native renal biopsy for NS between 2006 and 2017 yielding a diagnosis of primary glomerulonephritis were identified. Baseline serum albumin, proteinuria, estimated glomerular filtration rate, date of biopsy and histological diagnosis were recorded. 465 (238 male, 227 female) patients with nephrotic syndrome received the prophylactic anticoagulation regimen were included. Mean age at biopsy was 43,8±19,2 years. Median follow-up was 5,3±2,4 years. In addition to the prophylactic anticoagulation regimen, patients received treatment for their underlying glomerulopathy. This included optimising blood pressure control, renin-angiotensin system blockade, and prescribing immunosuppressive therapy if indicated. Patients received corticosteroid treatment or with renal failure were excluded from the study. 312 patients (67,1%) received treatment with UFH and 153 - with LMWH at some point in the course of their disease. There was no difference in mean age, sex, or disease duration between both groups. 276 patients were switched from UFH or LMWH to acenocoumarol as a result of protracted hypoalbuminemia (serum albumin &lt;2.0 g/dl) at a median time of 24,3±9,3 weeks' treatment. The anticoagulant control achieved in these patients was good. Bone mineral density (BMD) was measured at the lumbar spine and total hip region with dual x-ray absorptiometry. <h3>Results</h3> Results of Poisson regression analysis showed that LMWH therapy was associated with a lower risk of osteoporosis compared with UFH (0,7 vs 1,1 per 100 person-years). No statistically significant increase in the risk of fractures at 12 months was found for patients (RR = 1, 03; 95% CI: 0,27–3,34). UFH for 24 months decreased mean BMD by 2,6–3,5% (depending on the BMD site) compared to mean BMD decreases of 1,9–2,9% with LMWH. BMD of the spine and hip is significantly lower in patients with LMWH therapy than in subjects with UFH therapy, which is independent of age, sex, menopause, low BMI and altered body composition. <h3>Conclusions</h3> LMWH most likely have less effect on bone turnover when compared to UFH. LMWH for 6 months may not increase the risk of osteoporosis, but longer exposure for up to 24 months may adversely affect BMD. Clinicians should consider monitoring BMD in adults on long-term heparin therapy who are at increased risk of bone loss or fracture. <h3>Disclosure of Interest</h3> None declared