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

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 anticoagulant on bone density in adults. The effect size was assessed by standardized mean difference (SMD, exposed minus unexposed) and pooled by skeletal site; results are reported in standard deviation units. Bone density was significantly decreased among exposed subjects in the ultradistal radius (SMD, -0.39; 95% CI, -0.67 to -0.10) but not in the distal radius (SMD, -0.47; 95% CI, -0.97 to 0.04), lumbar spine (SMD, -0.27; 95% CI, -0.59 to 0.05), femoral neck (SMD, 0.03; 95% CI, -0.22 to 0.29) or femoral trochanter (SMD, -0.18; 95% CI, -0.48 to 0.11). The evidence should be considered with caution, but it is consistent with a negative association of oral anticoagulants with bone density in the ultradistal radius, although not in the spine or hip. This suggests that long-term oral anticoagulation might be associated with no more than a modest increase in osteoporotic fracture risk, but this should be verified in future longitudinal studies.

Vitamin K supplementation can improve stability of anticoagulation for patients with unexplained variability in response to warfarin

“…22 It is of theoretic concern that vitamin K supplementation, through the associated increase in warfarin dose requirements (by 16% Ϯ 15% in response to 150 g/day in this study), might lead to increased risk of bone fragility and osteoporotic fracture or arterial calcification. 23 However, in the absence of any experimental evidence for such risks, consideration of better anticoagulation control by vitamin K supplementation and its benefits in terms of reduction of risk of ischemic stroke and bleeding should prevail.…”

Vitamin K supplementation for meat quail in growth of 1 to 14 days old

“…Vitamin K is widely studied because the carboxylation of this vitamin is involved in bone metabolism, after all this vitamin is needed for carboxylation of glutamic acid, component of bone proteins, such as osteocalcin, and these carboxylated proteins have a higher affinity for calcium and are important in the incorporation thereof into the bone (BOOTH; MAYER, 2000;CARBALLO et al, 1999). Shearer (1995) reports that vitamin K is important in early skeletal development and maturation in the bone.…”

Effects of Long-Term Low-Molecular-Weight Heparin on Fractures and Bone Density in Non-Pregnant Adults: A Systematic Review With Meta-Analysis

“…74,75 Warfarin use was also shown to increase both bone loss and risk of vertebral fractures in some studies in women. 76,77 The potential adverse effects of LMWH on bone may be portrayed to be less when the comparator group has an increased likelihood for developing such adverse events. In light of our findings of a statistically nonsignificant increase in the risk of fractures between the groups [LMWH vs. control (UFH, VKA or placebo): RR = 0.58, 95 % CI: 0.23-1.43; LMWH vs. VKA: RR = 0.64, 95%CI: 0.24-1.71], one interpretation could be that long-term LMWH treatment poses a similar risk of fractures as UFH or VKA-a conclusion that needs further confirmation in large welldesigned prospective studies.…”