Changes in Bone Density after Exposure to Oral Anticoagulants: A Meta-analysis

  title={Changes in Bone Density after Exposure to Oral Anticoagulants: A Meta-analysis
  author={Pedro J. Caraballo and Sherine E. Gabriel and M Regina Castro and Elizabeth J. Atkinson and L Joseph Melton Iii},
  journal={Osteoporosis International},
Abstract: Oral anticoagulants are putative risk factors for osteoporosis, but observational cross-sectional studies describing their effects on bone mineral density have reported conflicting results, prospective studies are not available, and randomized trials are not feasible. To determine the association between exposure to oral anticoagulants and changes in bone density, we systematically reviewed nine original cross-sectional studies on the effect of long-term exposure to any oral… 

Long-term use of oral anticoagulants and the risk of fracture.

Long-term exposure to oral anticoagulation is associated with an increased risk of vertebral and rib fractures and the mechanism by which this occurs is still unclear and needs further investigation.

Reduced Bone Density in Children on Long-Term Warfarin

A case control study survey of bone density in children on long-term warfarin compared with randomly selected controls found a marked reduction in bone mineral apparent density of lumbar spine, which persisted after adjustment for age and body size.

Anticoagulants and Osteoporosis

Although anti-vitamin K agents (VKAs) have a significant impact on bone metabolism, and in particular, on osteocalcin, data on bone mineral density (BMD) and fractures are contrasting.

No effect of vitamin K1 intake on bone mineral density and fracture risk in perimenopausal women

In a group of perimenopausal and early postmenopausal women, vitamin K1 intake was not associated with effects on BMD or fracture risk, as well as close to the daily intake recommended by the Food and Agriculture Organization (FAO).

Assessment of Bone Mineral Density and Markers of Bone Turnover in Children Under Long-term Oral Anticoagulant Therapy

It seems that long-term use of coumarin derivatives may cause osteopenia in children with the risk of developing osteoporosis later in life.

A Systematic Review and Meta-analysis of the Association Between Vitamin K Antagonist Use and Fracture

There was a small increase in odds of fracture among female and elderly VKA users, which may not be clinically important when accounting for other considerations in choosing an anticoagulant.

Direct oral anticoagulants and the risk of osteoporotic fractures in patients with non-valvular atrial fibrillation

AF patients with different DOACs did not have different risks of osteoporotic fracture overall, however, additional concomitant morbidities, such as PAD or a history of hip fracture, and standard/low doses might be associated with different risks for differentDOACs.

Bone health and osteoporosis: the role of vitamin K and potential antagonism by anticoagulants.

  • D. Pearson
  • Medicine
    Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
  • 2007
The research suggests that at a minimum, clinicians should carefully assess anticoagulated patients for osteoporosis risk, monitor BMD, and refer them to dietitians for dietary and supplement advice on bone health.

Vitamin K supplementation reduces serum concentrations of under-gamma-carboxylated osteocalcin in healthy young and elderly adults.

Usual dietary practices in this population did not provide adequate vitamin K for maximal osteocalcin carboxylation and the effect of this intervention on skeletal turnover in healthy North American adults was evaluated.



Bone mineral density in patients given oral vitamin K antagonists.

Long-term vitamin K antagonist therapy does not affect bone mineral density at the lumbar spine or femoral neck and also fails to modify bone turnover markers, with the exception of osteocalcin.

Reduced Axial Bone Mineral Content in Patients Taking an Oral Anticoagulant

Osteocalcin serum levels were comparable between the two groups; bone density values measured at appendicular bone were significantly lower in patients taking acenocoumarol, and no significant correlation was found between duration of treatment and bone density.

Decreased peripheral bone mineral content in patients under anticoagulant therapy with phenprocoumon.

Data of decreased BMC and low serum OC-levels indicate reduced bone mass in patients on long-term anticoagulant therapy with phenprocoumon, which may imply an influence of antICOagulants on bone metabolism resulting in decreased bone formation.

[The effect of prolonged acenocoumarol therapy on bone density].

The effect of chronic cumarin treatment on bone mineral content was investigated. Bone mineral density was determined by double photon densitometry (Lunar DPXL). The density data (mean +/- SE) of 45

Decreased axial and peripheral bone density in patients taking long-term warfarin.

This study provides a new lead on post-menopausal osteoporosis, and supports the hypothesis that impaired carboxylation of osteocalcin plays a role in the pathogenesis of bone loss in the elderly through deficiency in vitamin K metabolism.

Serum undercarboxylated osteocalcin correlates with hip bone mineral density in elderly women

The data suggest that ucOC level may be an interesting marker in the investigation of bone status in the elderly, and multiple regression showed that uCOC has the highest predictive value for BMD when including age and body weight in the equation.

Relationship of Bone Turnover to Bone Density and Fractures

A substantial subset of elderly women has elevated bone turnover, which appears to adversely influence BMD and fracture risk, and combined biochemical and BMD screening may provide better prediction of future fracture risk than BMD alone.

Undercarboxylated osteocalcin measured with a specific immunoassay predicts hip fracture in elderly women: the EPIDOS Study.

It is found that ucOC, but not total OC, predicts hip fracture risk independently of femoral neck BMD in elderly women drawn from the general population, with low cross-reactivity with carboxylated OC and increased specificity and sensitivity over the HAP assay.

Phalangeal bone density and hip fracture risk.

Phalangeal bone density determined from standard hand x-ray films is a significant predictor of future hip fracture risk, and availability of a valid method to assess fracture risk using conventional radiographs will expand the ability to identify individuals with osteoporosis.