Incidence of Osteoporosis in Patients with Atrial Fibrillation Treated with Different Oral Anticoagulants
Previous research has suggested an increased risk of osteoporosis and osteoporotic fractures in patients with atrial fibrillation treated with warfarin. A recent analysis also identified a higher incidence of osteoporosis in patients treated with warfarin or direct oral anticoagulants (DOACs). However, less is known about the risk of this disease when using DOACs compared to warfarin. Therefore, Australian doctors compared its incidence in patients treated with different oral anticoagulants for atrial fibrillation (AF) in a population cohort study using data from a nationwide primary care database.
Evaluated Patient Population
This was an analysis of data from the nationwide electronic health records database MedicineInsight. Patients aged 18-111 years with AF, who had records of newly prescribed oral anticoagulants between 2013 and 2017, were included. A total of 18,454 patients (1714 with dabigatran, 5871 with rivaroxaban, 5248 with apixaban, and 5621 with warfarin) were analyzed, 39.5% of whom were women, with an average age of 73.2 years.
The authors used propensity score matching to eliminate potential confounding effects of baseline patient characteristics. The primary parameter monitored was the diagnosis of osteoporosis, and Cox proportional hazards models were used for statistical analysis.
Results
During an average follow-up period of 841 days, osteoporosis was diagnosed in 1627 patients (1028 on DOACs and 599 on warfarin). The weighted incidence rate of osteoporosis per 100 patient-years was 5.0 cases (95% confidence interval [CI] 4.7–5.2) with warfarin, 4.3 (3.8–4.8) with dabigatran, 3.6 (3.3–3.8) with rivaroxaban, and 4.4 (4.0–4.7) with apixaban.
The analysis showed a statistically significant lower risk of newly diagnosed osteoporosis with DOACs compared to warfarin (adjusted hazard ratio [aHR] 0.79; 95% CI 0.74-0.85, p < 0.001). The use of each individual DOAC was associated with a significantly lower incidence of osteoporosis compared to warfarin (aHR 0.75; 95% CI 0.69–0.82 for rivaroxaban; aHR 0.78; 95% CI 0.71–0.86 for apixaban; aHR 0.88; 95% CI 0.77–0.99 for dabigatran).
Conclusion
Data obtained from a large cohort of AF patients treated with oral anticoagulants in primary care show a lower risk of newly diagnosed osteoporosis when treated with DOACs compared to warfarin.
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Source: Bezabhe W. M., Radford J., Wimmer B. C. et al. Incidence of osteoporosis in primary care patients with atrial fibrillation receiving different oral anticoagulants. J Clin Med 2022; 11 (21): 6438, doi: 10.3390/jcm11216438.
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