Anticoagulants and Osteoporosis

• Published in: International journal of molecular sciences Vol. 20; no. 21; p. 5275
• Main Authors: Signorelli, Salvatore Santo, Scuto, Salvatore, Marino, Elisa, Giusti, Michele, Xourafa, Anastasia, Gaudio, Agostino
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 24.10.2019; MDPI
• Subjects: Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - pharmacology; Anticoagulants - therapeutic use; Bone and Bones - drug effects; Bone and Bones - metabolism; Bone density; Bone Density - drug effects; Disease prevention; Drug dosages; Fractures; Fractures, Bone - etiology; Heparin, Low-Molecular-Weight - adverse effects; Heparin, Low-Molecular-Weight - pharmacology; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Metabolism; Molecular weight; Osteoporosis; Osteoporosis - etiology; Phosphatase; Review; Stroke; Thromboembolism; Venous Thromboembolism - drug therapy; heparin; low molecular weight heparins (LMWHs); osteoporosis; anticoagulant agents; fracture; warfarin
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms20215275

Anticoagulant agents are widely used in the treatment of thromboembolic events and in stroke prevention. Data about their effects on bone tissue are in some cases limited or inconsistent (oral anti-vitamin K agents), and in others are sufficiently strong (heparins) to suggest caution in their use in subjects at risk of osteoporosis. This review analyses the effects of this group of drugs on bone metabolism, on bone mineral density, and on fragility fractures. A literature search strategy was developed by an experienced team of specialists by consulting the MEDLINE platform, including published papers and reviews updated to March 2019. Literature supports a detrimental effect of heparin on bone, with an increase in fracture rate. Low molecular weight heparins (LMWHs) seem to be safer than heparin. Although anti-vitamin K agents (VKAs) have a significant impact on bone metabolism, and in particular, on osteocalcin, data on bone mineral density (BMD) and fractures are contrasting. To date, the new direct oral anticoagulants (DOACs) are found to safe for bone health.