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Vitamin K is essential for development of normal bone density and achieving a dequate peak bone mass in childhood and is thought to be important in preventing the development of osteoporosis in later life. Warfarin, a vitamin K antagonist , is being used with greater frequency in children. The long- term effect of wa rfarin on bone density of children is not known. We performed a case control stu dy survey of bone density in children on long- term warfarin (n = 17, average d uration of warfarin treatment 8.2 y) compared with randomly selected controls (n = 321). There was a marked reduction in bone mineral apparent density of lumbar spine between patients and controls [patients 0.10 g/cm3; 95% confidence inte rval (CI), 0.93- 0.11 g/cm3, controls 0.12 g/cm3; 95% CI, 0.11- 0.12 g/cm3, p < 0.001). The lumbar spine areal bone mineral density Z- score of patients wa s reduced compared with controls [patients, - 1.96 (95% CI, - 2.52 to - 1.4 0). This difference persisted after adjustment for age and body size. The etiolo gy for the reduced bone density is likely to be multifactorial, however, screeni ng of children on longterm warfarin for reduced bone density should be considere d.
Vitamin K is essential for development of normal bone density and achieving a dequate peak bone mass in childhood and is thought to be important in preventing the development of osteoporosis in later life. Warfarin, a vitamin K antagonist, is being used with greater frequency in children The long-term effect of wa rfarin on bone density of children is not known. We performed a case control stu dy survey of bone density in children on long- term warfarin (n = 17, average d uration of warfarin treatment 8.2 y) There was a marked reduction in bone mineral apparent density of lumbar spine between patients and controls [patients 0.10 g / cm3; 95% confidence inte rval (CI), 0.93- 0.11 g / cm3 , controls 0.12 g / cm3; 95% CI, 0.11-0.12 g / cm3, p <0.001). The lumbar spine areal bone mineral density Z-score of patients wa reduced compared with controls [patients, - 1.96 , - 2.52 to - 1.4 0). This difference persisted after adjustment fo r age and body size. The etiolo gy for the reduced bone density is likely to be multifactorial, however, screeni ng of children on longterm warfarin for reduced bone density should be considere d.