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

Abstract

In experimental and clinical studies, conflicting results regarding the effect of oral anticoagulant therapy on bone metabolism have been reported. To measure a possible influence of long-term anticoagulant therapy with phenprocoumon on peripheral bone mass, measurements of peripheral bone mineral content (BMC) and serum osteocalcin levels were performed with single photon absorptiometry in a total of 78 patients on anticoagulant treatment. We studied 43 women (mean age 66 years +/- 2 SEM) and 35 men (mean age 65 years +/- 2 SEM) with a median duration of phenprocoumon therapy of 1 year (1-9 years). In all patients, the medical history gave no symptoms of metabolic bone disease, or diseases or medications causing osteoporosis. Both in the male and female groups, mean peripheral BMC was significantly decreased (male: P less than 0.01, female: P less than 0.003) when compared with corresponding controls. Serum OC-levels measured in 16 patients were also significantly lower than those of the controls (P less than 0.02). Our data of decreased BMC and low serum OC-levels indicate reduced bone mass in patients on long-term anticoagulant therapy with phenprocoumon. This may imply an influence of anticoagulants on bone metabolism resulting in decreased bone formation.

Antivitamin K prevents heterotopic ossification after hip arthroplasty in diffuse idiopathic skeletal hyperostosis: A retrospective study in 67 patients

“…The level of serum osteocalcin and the affinity of this protein for hydroxyapatite decreases after the ingestion of AVK in humans, thus explaining a decrease in bone formation and bone mineralization (Van Haarlem et al 1988). Moreover, axial and peripheral bone mineral content was found to be lower in adults taking vitamin K inhibitors than in controls (Fiore et al 1990, Resch et al 1991. This makes our findings biologically plausible.…”

Vitamin K-induced changes in markers for osteoblast activity and urinary calcium loss

“…The first indications in favor of this suggestion may be found in the recent observations of Akiba et al, who showed that loss of bone mass could be retarded in hemodialysis patients with a low-turnover bone disease by vitamin K administration [21], and by papers from two independent groups showing that patients exposed to long-term treatment with vitamin K antagonists have a significantly lower bone mass than age-and sex-matched controls [22,23]. As yet there are no indications for a regulation by Gla proteins of intestinal calcium absorption or glomerular filtration.…”

Effect of vitamin K intake on the stability of oral anticoagulant treatment: dose-response relationships in healthy subjects

“…Measurements of ucOC and cOC were considered relevant because of current concerns of the possible long-term consequences to health (osteoporosis and vascular calcification) of chronic vitamin K deficiency through nutritional lack 20,21 or OAC therapy. [22][23][24][25] In study phase II, we tested the effects of vitamin K-rich food items taken as a single meal. Although K 1 in green, leafy vegetables is the major dietary source of vitamin K for most populations, we also examined the antidotal properties of specific food items rich in vitamins K 2 (menaquinones; MKs); these forms appear to have a slower metabolic turnover than K 1 26 and hence the potential for producing a greater antidotal response.…”