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Reduced axial bone mineral content in patients taking an oral anticoagulant
C E Fiore1, C Tamburino, R Foti
1Department of Internal Medicine, University of Catania, Italy.
Abstract:
Recent literature indicates that the vitamin K cycle plays a role in the calcification process, presumably via its intervention on gamma-carboxylation of the noncollagenous proteins of bone osteocalcin and matrix gamma-carboxyglutamic acid protein. The major clinical evidence of this interference is fetal bone defect caused by oral anticoagulants given to the mother during the first trimester of pregnancy. No bone abnormalities have been reported so far in adults receiving oral anticoagulants. We studied 56 women who had had cardiac valve replacement and who were given acenocoumarol as anticoagulant, and 61 age-matched women who were in the same New York Heart Association functional class but who were not taking anticoagulants. Osteocalcin serum levels were comparable between the two groups; bone density values measured at appendicular bone were significantly lower in patients taking acenocoumarol. No significant correlation was found between duration of treatment and bone density. Significant osteopenia was present in the women being treated with oral anticoagulants.
Insights
Oral anticoagulants like acenocoumarol may cause bone loss in adults, specifically osteopenia. This study found lower bone density in women taking acenocoumarol compared to a control group.
Area of Science:
- Biochemistry
- Orthopedics
- Pharmacology
Background:
- The vitamin K cycle is implicated in bone calcification through gamma-carboxylation of proteins like osteocalcin.
- Fetal bone defects are known complications of maternal oral anticoagulant use during pregnancy.
- Adult bone abnormalities in patients on oral anticoagulants have not been previously reported.
Purpose of the Study:
- To investigate the effect of long-term oral anticoagulant therapy on bone density in adult women.
- To compare bone density and osteocalcin levels in women taking acenocoumarol versus age-matched controls.
Main Methods:
- A comparative study involving 56 women on acenocoumarol post-cardiac valve replacement and 61 age-matched controls.
- Measurement of serum osteocalcin levels.
- Assessment of bone mineral density at appendicular sites.
Main Results:
- Serum osteocalcin levels were similar between the acenocoumarol group and the control group.
- Women taking acenocoumarol exhibited significantly lower bone density at appendicular sites.
- No correlation was observed between the duration of acenocoumarol treatment and bone density.
- A significant prevalence of osteopenia was noted in the group receiving oral anticoagulants.
Conclusions:
- Long-term oral anticoagulant therapy with acenocoumarol is associated with reduced bone density in adult women.
- The mechanism may involve interference with bone metabolism, despite normal osteocalcin levels.
- Further research is warranted to understand the long-term skeletal effects of anticoagulation in adults.