Anticoagulants and Osteoporosis.
Salvatore Santo Signorelli1, Salvatore Scuto2, Elisa Marino3
1Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy. ssignore@unict.it.
International Journal of Molecular Sciences
|October 27, 2019
Summary
Heparin use may increase fracture risk, while newer direct oral anticoagulants (DOACs) appear safe for bone health. Low molecular weight heparins (LMWHs) show improved safety over traditional heparin.
Area of Science:
- Pharmacology
- Bone Metabolism
- Osteoporosis Research
Background:
- Anticoagulant agents are crucial for thromboembolic event treatment and stroke prevention.
- Concerns exist regarding the impact of anticoagulants on bone health, with varying data for different drug classes.
- Osteoporosis risk necessitates careful consideration of anticoagulant therapy effects on bone.
Purpose of the Study:
- To review the effects of anticoagulant agents on bone metabolism.
- To evaluate the impact of anticoagulants on bone mineral density (BMD) and fragility fractures.
- To compare the bone safety profiles of different anticoagulant classes.
Main Methods:
- Comprehensive literature search on MEDLINE up to March 2019.
- Inclusion of published papers and review articles on anticoagulant effects on bone.
- Analysis of data concerning bone metabolism, BMD, and fracture rates.
Main Results:
- Heparin demonstrates a detrimental effect on bone, associated with increased fracture rates.
- Low molecular weight heparins (LMWHs) appear safer for bone compared to unfractionated heparin.
- Anti-vitamin K agents (VKAs) affect bone metabolism, but BMD and fracture data remain inconsistent.
- Direct oral anticoagulants (DOACs) show no adverse effects on bone health to date.
Conclusions:
- Heparin necessitates caution in patients at risk of osteoporosis due to bone detrimental effects.
- LMWHs offer a potentially safer alternative to heparin regarding bone health.
- Further research is needed to clarify the long-term effects of VKAs on bone.
- DOACs represent a bone-safe option for anticoagulation therapy.
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