Anticoagulant use may exert unfavourable effects on bone health

Individuals who use anticoagulants appear to have decreased bone density and quality—an effect that is seen with direct-acting oral anticoagulants (DOACs) but more pronounced with warfarin, a study reports.

The study included 150 patients using oral anticoagulants for >1 year (DOAC, n=50; warfarin, n=50) and a paired control nonuser group (n=50). All patients completed a questionnaire and had their bone mineral density (BMD) and trabecular bone score (TBS) measured.

The mean age of the population was 60.49 years, and most participants were men (64 percent). Hypertension, dyslipidaemia, and hyperglycaemia were the most common comorbidities (comparison between groups, p>0.05).

Bone mass was low in 42 percent of patients in the control group, 50 percent in the DOAC group, and 66 percent in the warfarin group (p=0.012). Logistic regression analysis showed BMD to be associated with body mass index (BMI; odds ratio [OR], 0.846, 95 percent confidence interval [CI], 0.763–0.926; p=0.001), creatinine level (OR, 0.024, 95 percent CI, 0.001–0.434; p=0.017), and TBS value (OR, 17.777, 95 percent CI, 4.526–96.903; p=0.000). Specifically, TBS dropped progressively from the control to the DOAC and warfarin groups (mean: 1.328, 1.264, and 1.203, respectively; p<0.001).

Factors associated with low TBS included warfarin use (−0.06, 95 percent CI, –0.11 to −0.02; p=0.006), BMI (−0.01, 95 percent CI, –0.01 to −0.00; p<0.001), and hyperglycaemia (−0.07, 95 percent CI, –0.11 to −0.03; p=0.003), an active IPAQ classification (0.06, 95 percent CI, 0.01–0.11; p=0.029), and family history of hip fracture (0.07, 95 percent CI, 0.01–0.14; p=0.029).