Incidence of Osteoporosis in Primary Care Patients with Atrial Fibrillation Receiving Different Oral Anticoagulants

Woldesellassie M Bezabhe; Jan Radford; Barbara C Wimmer; Mohammed S Salahudeen; Ivan Bindoff; Gregory M Peterson

doi:10.3390/jcm11216438

Incidence of Osteoporosis in Primary Care Patients with Atrial Fibrillation Receiving Different Oral Anticoagulants

J Clin Med. 2022 Oct 30;11(21):6438. doi: 10.3390/jcm11216438.

Authors

Woldesellassie M Bezabhe¹, Jan Radford², Barbara C Wimmer¹, Mohammed S Salahudeen¹, Ivan Bindoff¹, Gregory M Peterson¹

Affiliations

¹ School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, TAS 7001, Australia.
² Launceston Clinical School, Tasmanian School of Medicine, University of Tasmania, 41 Frankland St., Launceston, TAS 7250, Australia.

Abstract

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). Conclusion: 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.

Keywords: apixaban; atrial fibrillation; dabigatran; oral anticoagulants; osteoporosis; primary care; rivaroxaban; warfarin.

Grants and funding

This research received no external funding.