Anticoagulants and Osteoporosis

Abstract

Anticoagulant agents are widely used in the treatment of thromboembolic events and in stroke prevention. Data about their effects on bone tissue are in some cases limited or inconsistent (oral anti-vitamin K agents), and in others are sufficiently strong (heparins) to suggest caution in their use in subjects at risk of osteoporosis. This review analyses the effects of this group of drugs on bone metabolism, on bone mineral density, and on fragility fractures. A literature search strategy was developed by an experienced team of specialists by consulting the MEDLINE platform, including published papers and reviews updated to March 2019. Literature supports a detrimental effect of heparin on bone, with an increase in fracture rate. Low molecular weight heparins (LMWHs) seem to be safer than heparin. 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. To date, the new direct oral anticoagulants (DOACs) are found to safe for bone health.

Effects of Neurological Disorders on Bone Health

“…Stroke patients also have higher energy expenditure, with this interruption of energy homeostasis potentially negatively impacting the skeleton during bone remodeling (Detrembleur et al, 2003;Lee et al, 2007;Driessler and Baldock, 2010). Additionally, reduced vitamin D levels, degree of recovery, increased fall risk, and use of anticoagulants may increase bone loss post-stroke (Jørgensen et al, 2000;Smith and Carroll, 2011;Batchelor et al, 2012;Signorelli et al, 2019). Thus, increased bone screening measures are needed in stroke patients, as screening may currently be infrequent (Kapoor et al, 2019).…”

Anticoagulation in hemodialysis: A narrative review

“…A theoretical adverse effect of heparin is osteoporosis 74 . Several in vitro and animal studies on the effects of heparin on osteogenesis showed controversial results, citing possible decreased osteoblastic or increased osteoclastic activity 74 .…”

“…A theoretical adverse effect of heparin is osteoporosis 74 . Several in vitro and animal studies on the effects of heparin on osteogenesis showed controversial results, citing possible decreased osteoblastic or increased osteoclastic activity 74 . In a crossover study of 40 patients on intermittent HD, anticoagulation was switched from UFH to low molecular weight heparin (LMWH), and biochemical markers for bone metabolism and bone densitometry were monitored longitudinally 73 .…”

Risk Factors and Management of Osteoporosis Post-Transplant

“…The general pre-transplant risk factors for osteoporosis include female sex (especially post-menopause women), BMI < 23 kg/m 2 , diabetes mellitus, malnutrition, a sedentary lifestyle, smoking, excessive alcohol, vitamin D deficiency, lack of sun exposure, hypogonadism with low estrogen and progesterone levels, number of falls, end-organ failure (including cardiac, liver and renal abnormalities) and preexisting bone mineral abnormalities [ 2 ]. Long term use of unfractionated heparin (by inhibiting osteoprotegerin and enhancing osteoclastic bone resorption) and coumadin (by inhibiting gamma-carboxylation of osteocalcin) could contribute to decreases in bone density [ 16 ]. The general risk factors for osteoporosis are illustrated in Figure 2 .…”