Key result
DOACs are linked to a ~29% lower risk of new-onset osteoporosis versus warfarin.
Why the study?
Evidence on the association between oral anticoagulants and the risk of new-onset osteoporosis remains controversial.
Do direct oral anticoagulants (DOACs) reduce the risk of new-onset osteoporosis compared to warfarin in patients requiring oral anticoagulation?
Meta-Analysis (n=74,338)
Do direct oral anticoagulants (DOACs) reduce the risk of new-onset osteoporosis compared to warfarin in patients requiring oral anticoagulation?
Hazard Ratio: 0.71 (95% CI 0.57–0.88)
Absolute Event Rate: 3.7% vs 4.9%
p-value: p=< 0.001
DOACs are associated with a lower incidence of new-onset osteoporosis compared to warfarin, suggesting a safer bone profile for patients requiring long-term anticoagulation.
Supports preferring DOACs over warfarin for long-term anticoagulation to lower osteoporosis risk; extends meta-analytic data but needs RCT confirmation.
Aims: Evidence on the association between the risk of new-onset osteoporosis and oral anticoagulants remains controversial. We aimed to compare the risk of osteoporosis associated with the use of direct oral anticoagulants (DOACs) with that associated with warfarin use. Methods: Studies published up to 15 March 2023 that investigated the association between the use of DOACs and warfarin and the incidence of osteoporosis were identified by online searches in PubMed, Embase, the Cochrane Library, and Web of Science conducted by two independent investigators. Random-effects or fixed-effect models were employed to synthesize hazard ratios (HRs)/relative ratios (RRs) with 95% confidence intervals (CIs) for estimating the risk of osteoporosis correlated with DOAC and warfarin prescriptions (PROSPERO No. CRD42023401199). Results: : 85.1%). Subanalyses revealed that rivaroxaban was associated with a lower risk of osteoporosis than both warfarin and dabigatran. In addition, DOACs were associated with a lower risk of developing osteoporosis than warfarin in both male and female patients, in patients with atrial fibrillation (AF), and in patients who underwent therapy for > 365 days. Conclusion: DOAC users experienced a lower incidence of osteoporosis than warfarin users. This study may give us insight into safe anticoagulation strategies for patients who are at high risk of developing osteoporosis. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023401199.
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Liu et al. (2023) conducted a meta-analysis in Conditions requiring oral anticoagulants (primarily atrial fibrillation) (n=74,338). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on New-onset osteoporosis (HR 0.71, 95% CI 0.57 to 0.88, p=< 0.001). Direct oral anticoagulant use was associated with a 29% lower risk of new-onset osteoporosis compared to warfarin use (HR 0.71).
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