Risk of osteoporosis in patients with atrial fibrillation with and without oral anticoagulant therapy

ABSTRACT

Background

We aimed to compare the risk of developing osteoporosis in patients prescribed warfarin or direct-acting oral anticoagulants (DOACs) with those with no therapy.

Research design and methods

We included 37,632 patients aged between 18 and 111 years with a recorded diagnosis of AF between 1 January 2013 and 31 December 2017. Patients were followed until the diagnosis of osteoporosis, switch or discontinuation of the OAC, last clinical visit, or end of the study period, whichever occurred first. The incidences of new-onset osteoporosis were calculated using the Cox proportional hazards model.

Results

Of total, 16,995 (45.2%) had no recorded OAC prescription, and 20,637 had a recorded prescription of warfarin (6,609) or DOAC (14,028). Compared with those not prescribed an OAC, the risk of being diagnosed with new-onset osteoporosis increased in patients prescribed warfarin (HR 2.22, 95% CI 2.00–2.47, p < 0.001) and DOACs (HR 1.42, 95% CI 1.29–1.58, p < 0.001). However, the effect of DOACs was not statistically significant (HR 1.07, 95% CI 0.86–1.33, p < 0.535) after excluding patients with at least one recorded prescription of systemic corticosteroids, antiepileptics, or proton pump inhibitors.

Conclusions

Use of warfarin or DOACs was associated with a significantly increased risk of developing osteoporosis compared with no OAC treatment.

KEYWORDS:

• Oral anticoagulant
• atrial fibrillation
• osteoporosis
• warfarin
• direct acting oral anticoagulant

Acknowledgments

We are thankful to the general practices and general practitioners that participate in MedicineInsight, and the patients who allow the use of de-identified information.

Author contributions

WM Bezabhe prepared and analysed data and drafted and revised the manuscript. J Radford, BC Wimmer, MS Salahudeen, I Bindoff, T Ling and GM Peterson participated in the design and concept of the study and critically revised the manuscript. All authors agreed on the article’s final version and took responsibility for the article’s contents.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

Data for this study is not available publicly. However, researchers can obtain data from MedicineInsight. Available from: https://www.nps.org.au/medicine-insight

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Funding

This paper was not funded.