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Bone Density in Children with Single Ventricle Physiology

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Abstract

Children with chronic diseases are at risk for low bone mineral density (BMD). There are no studies of BMD in children with congenital heart disease and particularly single ventricle (SV). Children with this defect are often treated with warfarin, suspected to negatively impact BMD in adults. We assessed BMD in patients with SV physiology and compared the BMD of subjects taking warfarin to those who were not. Subjects 5–12 years with SV were included. BMD z scores by dual-energy X-ray absorptiometry of the spine and total body less head (TBLH) were obtained. Calcium intake, activity level, height, and Tanner stage were assessed. Linear regression models and t tests were used to investigate differences between participants and normative data as well as between subjects’ subgroups. Twenty-six subjects were included and 16 took warfarin. Mean BMD z score at the spine was significantly lower than expected at −1.0 ± 0.2 (p < 0.0001), as was the BMD z score for TBLH at −0.8 ± 0.2 (p < 0.0001). Those results remained significant after adjusting for height. Subjects who were on warfarin tended to have lower BMD at both the spine and TBLH than those who were not, with a z score difference of 0.6 ± 0.46 at the spine (p = 0.106) and a difference of 0.4 ± 0.34 at TBLH (p = 0.132). BMD is significantly reduced in children with SV. Warfarin appears to lower BMD but the effect is less conclusive. Continued evaluation is recommended for these patients at risk for reduced bone density. Evaluation of other cardiac patients on warfarin therapy should also be considered.

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Acknowledgments

This work was funded by Suzanne P. Murphy Foundation, Bethesda, MD (Roger Hurwitz, MD, PI) and William Fadel was partially supported by TL1 RR025759, Indianapolis, IN (Anantha Shekhar, PI ).

Conflict of interest

None of the authors had any conflict of interest related to the study.

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Authors and Affiliations

  1. Section of Pediatric Cardiology, Department of Pediatrics, Sanford Children’s Hospital, University of South Dakota, 1600 W 22nd Street, PO Box 5039, Sioux Falls, SD, 57117, USA

    Edgard A. Bendaly

  2. Section of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA

    Linda A. DiMeglio

  3. Department of Biostatistics, Indiana University, 714 N. Senate Avenue, Indianapolis, IN, 46202, USA

    William F. Fadel

  4. Section of Pediatric Cardiology, Department of Pediatrics, Indiana University, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA

    Roger A. Hurwitz

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  1. Edgard A. Bendaly
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  2. Linda A. DiMeglio
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  3. William F. Fadel
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  4. Roger A. Hurwitz
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Correspondence to Edgard A. Bendaly.

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Bendaly, E.A., DiMeglio, L.A., Fadel, W.F. et al. Bone Density in Children with Single Ventricle Physiology. Pediatr Cardiol 36, 779–785 (2015). https://doi.org/10.1007/s00246-014-1083-3

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  • DOI: https://doi.org/10.1007/s00246-014-1083-3

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