Trabecular bone score (TBS) and bone mineral density in patients with long-term therapy with warfarin

In this study, we compared patients using the anticoagulant warfarin for more than a year with a control group with similar characteristics but without using the drug. We demonstrated worse BMD and bone quality by trabecular bone score (TBS) in patients using warfarin for more than 1 year.

Evaluate the bone mineral density (BMD) and the trabecular bone score (TBS) of patients taking warfarin for more than 1 year compared with a control group.

Male patients aged 25-65 years in warfarin use for more than 1 year were included. Patients answered a questionnaire regarding lifestyle habits and realized a dual X-ray densitometry (DXA) (lumbar spine and hip), and TBS was evaluated.

From the 96 patients invited, 33 patients accepted to participate and comprised the warfarin group (WG), and 3 were excluded. The control group (CG) was composed of 21 individuals matched by age and race. The mean age of WG was 57.0 ± 7.6 and in the CG 54.0 ± 10.6 years (p = 0.095). The BMD in WG was lower than that in the CG in all sites (spine p < 0.001, total hip p = 0.001, and femoral neck p = 0.005). A longer time of warfarin use increased the likelihood of having low BMD (OR = 1.239, CI 1.064-1.674, p = 0.01), whereas high BMI decreased it (OR = 0.732, CI 0.533-0.918, p = 0.03). The TBS was lower in WG than the CG (p = 0.04). Lower TBS was associated with hypertension in both groups and to the hip BMD (neck and total) (p < 0.005) in the WG. In the multivariate analysis, only hypertension (- 0.10, CI - 0.17 to - 0.03, p = 0.008) and total hip BMD ( 0.26, CI 0.07-0.46, p = 0.009) influenced TBS.

We demonstrated an association between worsening of BMD and bone quality in patients taking warfarin for more than 1 year.