WASHINGTON, DC—The use of furosemide in children with congenital heart disease (CHD) may increase the risk of bone fractures in these patients, according to findings presented at the ACC.17 Scientific Session.

Patients with CHD are often prescribed furosemide, a loop diuretic that has been tied to loss of bone mineral density. To investigate what effect furosemide treatment has on the incidence of bone fractures in children with CHD, researchers extracted data from the Texas Medicaid databases.

To be included in the study, children had to have a diagnosis of either CHD, cardiomyopathy or heart failure and be <12 years of age. The study patients were then put into three groups: furosemide-adherent (medication possession ratio ≥70%) (n=254), furosemide non-adherent (medication possession ratio <70%) (n=724), and no furosemide (n=2,934). To compare the three groups, logistic regression and Cox proportional hazard model with a Kaplan-Meier plot were used.

The furosemide-adherent group was found to have had the highest incidence of fracture with 9.06% followed by the furosemide non-adherent group (7.18%) and lastly by the no furosemide group (5.04%). Compared to no furosemide, both furosemide groups were more likely to have fractures using logistic regression (furosemide-adherent group odds ratio [OR] 1.87, 95% CI: 1.17–2.98; P=0.009); furosemide-non-adherent group (OR 1.53, 95% CI: 1.10–2.14; P=0.011). In addition, compared to the no furosemide group, the risk of fractures for the furosemide-adherent group was significantly higher (HR 1.56; 95% CI: 1.01–2.42; P=0.049).

“Clinicians who treat patients with heart disease should be aware of the increased risk of fractures and screen for bone disease in this patient population,” concluded the authors.