Author + information
- Received April 7, 2019
- Revision received August 1, 2019
- Accepted August 5, 2019
- Published online October 21, 2019.
- Casper Binding, BMedSca,b,c,∗ (, )@BindingCasper@uni_copenhagen@CopCard,
- Jonas Bjerring Olesen, MD, PhDa,c,
- Bo Abrahamsen, MD, PhDd,e,
- Laila Staerk, MDa,c,
- Gunnar Gislason, MD, PhDa,c,f and
- Anders Nissen Bonde, MDa,c
- aDepartment of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- bDepartments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- cDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- dOdense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- eDepartment of Medicine, Holbæk Hospital, Holbæk, Denmark
- fThe Danish Heart Foundation, Copenhagen, Copenhagen, Denmark
- ↵∗Address for correspondence:
Casper Binding, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Post 635, Kildegaardsvej 28, 2900 Hellerup, Denmark.
Background Elderly patients in long-term treatment with vitamin K antagonists (VKAs) are at high risk of osteoporotic fractures compared with the background population. It has been speculated that the choice of oral anticoagulant (OAC) may affect the risk of osteoporotic fractures.
Objectives The risk of osteoporotic fractures was evaluated among patients with atrial fibrillation treated with VKA or direct oral anticoagulants (DOACs).
Methods Patients were identified using the Danish national registries. Patients were included only if they had no prior use of osteoporosis medication and they had undergone 180 days of OAC treatment. Outcomes were hip fracture, major osteoporotic fracture, any fracture, initiation of osteoporosis medication, and a combined endpoint.
Results Overall, 37,350 patients were included. The standardized absolute 2-year risk of any fracture was low among DOAC-treated patients (3.1%; 95% CI: 2.9% to 3.3%) and among VKA-treated patients (3.8%; 95% CI: 3.4% to 4.2%). DOAC was associated with a significantly lower relative risk of any fracture (hazard ratio [HR]: 0.85; 95% CI: 0.74 to 0.97), major osteoporotic fractures (HR: 0.85; 95% CI: 0.72 to 0.99), and initiating osteoporotic medication (HR: 0.82; 95% CI: 0.71 to 0.95). A combined endpoint showed that patients treated with DOAC had a significantly lower relative risk of experiencing any fracture or initiating osteoporosis medication (HR: 0.84; 95% CI: 0.76 to 0.93).
Conclusions In a nationwide population, the absolute risk of osteoporotic fractures was low among patients with atrial fibrillation on OAC, but DOAC was associated with a significantly lower risk of osteoporotic fractures compared with VKA.
- atrial fibrillation
- direct oral anticoagulants
- osteoporotic fracture
- vitamin k antagonists
This study was funded by a scholarship from The Copenhagen University Hospital Herlev and Gentofte received by Casper Binding. No funder or sponsor had any influence on the study design, interpretation of results, or the decision to submit the manuscript for publication. Dr. Gislason has received research grants from Pfizer, Bristol-Myers Squibb, Bayer, and Boehringer Ingelheim. Dr. Oleson has served as a speaker for Bristol-Myers Squibb, Boehringer Ingelheim, Bayer, and AstraZeneca; has served as a consultant for Bristol-Myers Squibb, Boehringer Ingelheim, Novartis Healthcare, and Novo Nordisk; and has received funding for research from Bristol-Myers Squibb and The Capital Region of Denmark, Foundation for Health Research. Dr. Abrahamsen has received institutional research grants from Union Chimique Belge and Novartis; has received speaker fees from Amgen; and has received consulting fees from Union Chimique Belge. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 7, 2019.
- Revision received August 1, 2019.
- Accepted August 5, 2019.
- 2019 American College of Cardiology Foundation
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