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Incidence of Osteoporosis in Primary Care Patients with atrial fibrillation receiving different oral anticoagulants


Bezabhe, WM and Radford, J and Wimmer, BC and Salahudeen, MS and Bindoff, B and Peterson, GM, Incidence of Osteoporosis in Primary Care Patients with atrial fibrillation receiving different oral anticoagulants, Journal of Clinical Medicine, 11, (21) Article 6438. ISSN 2077-0383 (2022) [Refereed Article]


Copyright Statement

Copyright 2022 The Authors Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

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DOI: doi:10.3390/jcm11216438


Background:Studies investigating the association between the use of oral anticoagulants (OACs) and osteoporosis are limited. We aimed to determine the risk of osteoporosis in patients with atrial fibrillation (AF) and receiving different OACs. Methods: We performed a population-based cohort study using a nationwide primary care dataset, MedicineInsight. Patients aged between 18 and 111 years with AF and newly recorded OAC prescriptions between 1 January 2013 and 31 December 2017 were included and followed until 31 December 2018. We applied propensity score matching to control for patients’ baseline characteristic differences before calculating adjusted hazard ratios (aHRs) for a new diagnosis of osteoporosis, using Cox proportional hazard models.

Results:A total of 18,454 patients (1714 prescribed dabigatran, 5871 rivaroxaban, 5248 apixaban and 5621 warfarin) were included. Of these, 39.5% were females, and the overall mean age (standard deviation [SD] was 73.2(10.3) years. Over a mean follow-up of 841 days, 1627 patients (1028 receiving direct-acting oral anticoagulants (DOACs) and 599 warfarin) had a newly recorded diagnosis of osteoporosis. The weighted incidence rates (95% confidence interval; CI) per 100 person-years of treatment were 5.0 (4.7–5.2) for warfarin, 4.3 (3.8–4.8) for dabigatran, 3.6 (3.3–3.8) for rivaroxaban, and 4.4 (4.0–4.7) for apixaban. Overall, DOAC use was associated with a significantly lower risk of a new diagnosis of osteoporosis than warfarin use (aHR, 0.79, 95% confidence interval (CI) 0.74–0.85; p < 0.001). Use of each individual DOAC was associated with a significantly lower risk of osteoporosis compared with warfarin (aHRs, 0.75, 95% CI 0.69–0.82 for rivaroxaban; 0.78, 95% CI 0.71–0.86 for apixaban; 0.88, 95% CI 0.77–0.99 for dabigatran).

Conclusions:Compared with warfarin, the use of DOACs was associated with a significantly lower risk of developing osteoporosis in patients with AF. This association remained significant when individual DOACs were compared with warfarin.

Item Details

Item Type:Refereed Article
Keywords:osteoporosis; oral anticoagulants; warfarin; dabigatran; rivaroxaban; apixaban; atrial fibrillation; primary care
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Efficacy of medications
UTAS Author:Bezabhe, WM (Dr Woldesellassie Bezabhe)
UTAS Author:Radford, J (Professor Jan Radford)
UTAS Author:Wimmer, BC (Dr Barbara Wimmer)
UTAS Author:Salahudeen, MS (Dr Mohammed Salahudeen)
UTAS Author:Bindoff, B (Dr Ivan Bindoff)
UTAS Author:Peterson, GM (Professor Gregory Peterson)
ID Code:154112
Year Published:2022
Deposited By:Pharmacy
Deposited On:2022-10-30
Last Modified:2022-11-08
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