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Vitamin K antagonists do not affect bone mineral density, fracture risk
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Vitamin K antagonists do not increase the risk for fracture or reduce bone mineral density, according to findings published in the Journal of Thrombosis and Haemostasis.
“Because osteocalcin, a protein produced by osteoblasts, undergoes the same carboxylation process [as vitamin K], the inhibition of the gamma-carboxylation exerted by vitamin K antagonists leads to lower incorporation in the bone matrix,” the researchers write. “Undercarboxylated osteolcalcin serum levels increase with the use of vitamin K antagonists, but whether this translates into fracture risk or lower bone mineral density values is still controversial.”
Nicola Veronese, MD, of the department of medicine, geriatrics section, at the University of Padova in Italy, and fellow researchers examined data from 79,663 patients treated with vitamin K antagonists and 597,348 controls, which included healthy individuals and patients with a medical illness. All participants were identified through a literature search.
Nicola Veronese
Two investigators completed the PubMed and Embase search from database inauguration through August 2014 for studies that compared fractures and bone mineral density among patient and control groups. Cross-sectional and longitudinal studies were selected.
Altogether, 21 studies were included for analysis. Patients treated with vitamin K antagonists were found to have a higher risk for fracture in both cross-sectional (three studies; RR = 1.24; 95% CI, 1.12-1.39) and longitudinal (seven studies; RR = 1.09; 95% CI, 1.01-1.18) investigations, as well as more incident hip fractures (four studies; RR = 1.17; 95% CI, 1.05-1.31). However, when studies that matched patients treated with vitamin K antagonists with healthy controls were evaluated (n = 4), findings in longitudinal studies became nonsignificant.
Bone mineral density values were similar among patients treated with vitamin K antagonists and medical controls at all study sites. The researchers note that one study showed lower spine T-scores in patients treated with vitamin K antagonists as compared with healthy controls (standardized mean difference, –0.45; 95% CI, –0.75 to –0.14).
“The use of [vitamin K antagonists] seems to neither significantly increase fracture risk when matching on confounding factors nor reduce [bone mineral density] beyond effects of medical illness,” the researchers write. “Since the use of [vitamin K antagonist] treatment, as well as osteoporosis and fractures, are continuously increasing, particularly in older people, future studies using appropriate matching procedures, following patients for sufficiently long periods and including newer oral anticoagulants are needed to clarify the short- and long-term effects of [vitamin K antagonists] on bone health.” – by Julia Ernst, MS
Disclosure: Veronese reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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