Log in to MyACC
Osteoporotic Fractures in AF Patients on VKA vs. DOAC
Study Questions:
What is the risk of osteoporotic fractures in patients with atrial fibrillation (AF) treated with vitamin K antagonists (VKA) versus direct oral anticoagulants (DOAC)?
Methods:
Using the Danish national registry, patients with AF were identified and grouped into two cohorts based on their anticoagulant use: VKA versus DOAC. Patients with prior osteoporosis medication use were excluded. Outcomes assessed included hip fracture, major osteoporotic fracture, any fracture, and initiation of osteoporosis medication. Hazard ratios were adjusted for age, comorbidities, and medication use.
Results:
Among 37,350 patients in the study, the standardized 2-year risk of any fracture was lower among DOAC-treated patients than VKA-treated patients (3.1% vs. 3.8%, adjusted hazard ratio [aHR], 0.85; 95% confidence interval [CI], 0.74-0.97). The risks of major osteoporotic fracture (aHR, 0.85; 95% CI, 0.72-0.99) and initiating osteoporosis medication (aHR, 0.82; 95% CI, 0.71-0.95) were also lower in DOAC- versus VKA-treated patients with AF.
Conclusions:
The authors concluded that the absolute risk of osteoporotic fractures and initiating osteoporosis medications was lower among patients with AF treated with DOAC versus VKA.
Perspective:
Chronic use of VKA has long been associated with a small, but increased risk of osteoporosis and osteoporotic fractures. This has been suggested due to a link between VKA and undercarboxylated osteocalcin, which is associated with bone mineral density. This nationwide cohort study suggests that use of DOAC therapy, rather than VKA, is associated with a lower risk of osteoporosis and osteoporotic fractures. This is plausible, since DOAC medications inhibit the clotting cascade through a mechanisms independent of protein carboxylation. In addition to the other benefits of DOAC therapy (e.g., lower risk of intracranial hemorrhage, more consistent dosing), the lower risk of osteoporotic fracture may provide further (albeit nonrandomized) evidence in favor of DOAC use among older patients with AF at high risk for complications.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Dyslipidemia, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism
Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Blood Coagulation, Bone Density, Hip Fractures, Intracranial Hemorrhages, Osteocalcin, Osteoporosis, Osteoporotic Fractures, Risk, Secondary Prevention, Treatment Outcome, Vitamin K
< Back to Listings
