Bone density and quality in patients treated with direct-acting oral anticoagulants versus warfarin

Nalevaiko, Jeferson Zanovelli; Marques, Júlia Vieira Oberger; Oliveira, Matheus Felipe; Raetsch, Arthur William Passos; Marques, Gustavo Lenci; Petterle, Ricardo Rasmussen; Moreira, Carolina Aguiar; Borba, Victória Zeghbi Cochenski

Affiliations

¹Cardiology Division, Hospital de Clínicas, Universidade Federal do Paraná (HC/UFPR), Rua General Carneiro, 181 Curitiba, PR, Brazil

²Endocrine Division, Hospital de Clínicas, Universidade Federal do Paraná (SEMPR), Avenida Agostinho Leão Júnior, 285, Alto da Glória, Curitiba, PR, Brazil

³Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil

⁴Sector of Health Sciences, Medical School, Universidade Federal do Paraná, Curitiba, PR, Brazil

Abstract and keywords

Introduction: 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.

Methods: Cross-sectional, observational study in patients using oral anticoagulants for >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 (comparison between groups p > 0.05). Low bone mass was diagnosed in 42%, 50%, and 66% of the patients in the CG, DOACG, and WG, respectively (p = 0.012). On logistic regression analysis, BMD was associated with body mass index (BMI; odds ratio [OR] 0.846, 95% confidence interval [CI] 0.763–0.926, p = 0.001), creatinine level (OR 0.024, 95%CI 0.001–0.434, p = 0.017), and TBS value (OR 17.777, 95%CI 4.526–96.903, p = 0.000). The mean TBS decreased progressively from the CG to the DOACG and WG (1.328 ± 0.112, 1.264 ± 0.138, and 1.203 ± 0.112, respectively, p < 0.001). On multivariate linear regression, negative predictors of TBS included warfarin use (−0.06, 95%CI -0.11 to −0.02, p = 0.006), BMI (−0.01, 95%CI -0.01 to −0.00, p < 0.001), and hyperglycemia (−0.07, 95%CI -0.11 to −0.03, p = 0.003), while positive predictors were an active IPAQ classification (0.06, 95%CI 0.01–0.11, p = 0.029) and family history of hip fracture (0.07, 95%CI 0.01–0.14, p = 0.029).

Conclusion: 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.

Keywords: Osteoporosis; Densitometry; Trabecular bone score; Oral anticoagulants; DOACs; Warfarin

Links

DOI: 10.1016/j.bone.2021.116000

PubMed: 33971316

WoS: 000670402300012

History

Received: 2020-10-26

Revised: 2021-05-1

Accepted: 2021-05-1

Online: 2021-05-8

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Cited By (1)

Year	Entry
2022	Zhou J, Lee S, Liu X, Satti DI, Lee TTL, Chou OHI, Chang C, Roever L, Wong WT, Wai AKC, Liu T, Zhang Q, Tse G. Hip fractures risks in edoxaban versus warfarin users: a propensity score-matched population-based cohort study with competing risk analyses. Bone. March 2022;156:116303.