Oral anticoagulants may lower bone density, trabecular bone
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Adults prescribed any oral anticoagulation therapy have lower bone mineral density and trabecular bone score compared with controls, with a stronger negative effect observed among those prescribed warfarin, data published in Bone show.

Direct-acting oral anticoagulants (DOACs) are therapeutic alternatives to warfarin that act independently of vitamin K, thus not affecting bone matrix formation. The aim of this study was to compare bone mineral density (BMD) and microarchitecture in patients treated with DOACs versus warfarin.

This was a cross-sectional, observational study in patients using oral anticoagulants for more than 1 year and a paired control group (CG). Based on the type of anticoagulant used, the patients were grouped into a DOAC (DOACG) or warfarin (WG) group. All patients filled out a questionnaire and underwent BMD evaluation and trabecular bone score (TBS) measurement.

Results:
-- In all, 150 patients were included (50 patients in each group).

-- The mean age was 60.49 ± 7.48 years, and most participants were men (64%).

-- The most frequent comorbidities were hypertension, dyslipidemia, and hyperglycemia.

-- Low bone mass was diagnosed in 42%, 50%, and 66% of the patients in the CG, DOACG, and WG, respectively.

-- On logistic regression analysis, BMD was associated with body mass index, creatinine level and TBS value.

-- The mean TBS decreased progressively from the CG to the DOACG and WG.

-- On multivariate linear regression, negative predictors of TBS included warfarin use, BMI, and hyperglycemia, while positive predictors were an active IPAQ classification and family history of hip fracture.

Conclusively, patients using anticoagulants have lower BMD and TBS values compared with controls. This negative effect on bone was more pronounced with warfarin, but was also seen with DOACs.

Source: https://www.sciencedirect.com/science/article/abs/pii/S8756328221001629?via=ihub
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