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Fracture risk in users of oral anticoagulants: a nationwide case-control study.
Int J Cardiol 2007; 118(3):338-44IJ

Abstract

BACKGROUND

Vitamin K antagonists (VKA) are often used as oral anticoagulants in order to prevent thromboembolic diseases. In bone, vitamin K reduces bone resorption and functions as a cofactor in the posttranslational carboxylation of several bone proteins. Discrepant results have been reported on whether VKA affects bone mineral density and fracture risk.

AIM

In a nationwide population-based pharmaco-epidemiological case-control study we assessed fracture risk in users of VKA.

METHODS

We compared 124,655 cases that sustained a fracture during year 2000 with 373,962 age- and gender-matched controls. We used computerized registers to assess individual drug use and related these data to individual fracture data and information on confounders.

RESULTS

VKA was used in 2.2% of the cases and in 1.6% of the controls (crude OR 1.34; 95% CI, 1.28-1.41). After confounder adjustment, current use of VKA was associated with an increased risk of any fracture (OR 1.10; 95%CI, 1.03-1.18). Fracture risk was not increased in former users. Dose-effect analysis showed that only those who had used a relatively low accumulated dose of VKA (less than 100 defined daily dosages) had an increased risk of any fracture (adj. OR 1.49; 95%CI, 1.31-1.69), as well as an increased risk of fractures at the hip (adj. OR 1.43; 95%CI, 1.09-1.87) and forearm (adj. OR 1.42; 95%CI, 1.02-1.97).

CONCLUSION

Current use of small, accumulated amounts of VKA is associated with an increased fracture risk. This may be due to circumstances related to the disease necessitating therapy as well as due to a pharmacological effect.

Authors+Show Affiliations

Department of Endocrinology and Metabolism, Aarhus University Hospital, Aarhus Sygehus, Tage Hansens Gade 2, Aarhus C, Denmark. rejnmark@post6.tele.dk <rejnmark@post6.tele.dk>No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17055083

Citation

Rejnmark, Lars, et al. "Fracture Risk in Users of Oral Anticoagulants: a Nationwide Case-control Study." International Journal of Cardiology, vol. 118, no. 3, 2007, pp. 338-44.
Rejnmark L, Vestergaard P, Mosekilde L. Fracture risk in users of oral anticoagulants: a nationwide case-control study. Int J Cardiol. 2007;118(3):338-44.
Rejnmark, L., Vestergaard, P., & Mosekilde, L. (2007). Fracture risk in users of oral anticoagulants: a nationwide case-control study. International Journal of Cardiology, 118(3), pp. 338-44.
Rejnmark L, Vestergaard P, Mosekilde L. Fracture Risk in Users of Oral Anticoagulants: a Nationwide Case-control Study. Int J Cardiol. 2007 Jun 12;118(3):338-44. PubMed PMID: 17055083.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fracture risk in users of oral anticoagulants: a nationwide case-control study. AU - Rejnmark,Lars, AU - Vestergaard,Peter, AU - Mosekilde,Leif, Y1 - 2006/10/18/ PY - 2006/03/02/received PY - 2006/07/09/accepted PY - 2006/10/24/pubmed PY - 2007/7/24/medline PY - 2006/10/24/entrez SP - 338 EP - 44 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 118 IS - 3 N2 - BACKGROUND: Vitamin K antagonists (VKA) are often used as oral anticoagulants in order to prevent thromboembolic diseases. In bone, vitamin K reduces bone resorption and functions as a cofactor in the posttranslational carboxylation of several bone proteins. Discrepant results have been reported on whether VKA affects bone mineral density and fracture risk. AIM: In a nationwide population-based pharmaco-epidemiological case-control study we assessed fracture risk in users of VKA. METHODS: We compared 124,655 cases that sustained a fracture during year 2000 with 373,962 age- and gender-matched controls. We used computerized registers to assess individual drug use and related these data to individual fracture data and information on confounders. RESULTS: VKA was used in 2.2% of the cases and in 1.6% of the controls (crude OR 1.34; 95% CI, 1.28-1.41). After confounder adjustment, current use of VKA was associated with an increased risk of any fracture (OR 1.10; 95%CI, 1.03-1.18). Fracture risk was not increased in former users. Dose-effect analysis showed that only those who had used a relatively low accumulated dose of VKA (less than 100 defined daily dosages) had an increased risk of any fracture (adj. OR 1.49; 95%CI, 1.31-1.69), as well as an increased risk of fractures at the hip (adj. OR 1.43; 95%CI, 1.09-1.87) and forearm (adj. OR 1.42; 95%CI, 1.02-1.97). CONCLUSION: Current use of small, accumulated amounts of VKA is associated with an increased fracture risk. This may be due to circumstances related to the disease necessitating therapy as well as due to a pharmacological effect. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/17055083/Fracture_risk_in_users_of_oral_anticoagulants:_a_nationwide_case_control_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(06)00852-7 DB - PRIME DP - Unbound Medicine ER -