Use of NOACs in diabetes with AF tied to decreased risk of osteoporotic fractures compared to warfarin

CHINA: In individuals with type 2 diabetes with atrial fibrillation, usage of non-vitamin K antagonist oral anticoagulants was linked to a decreased incidence of severe osteoporotic fractures than warfarin use, according to a study published in Diabetes Care Journal.

Due to diminished bone turnover and compromised bone microarchitecture, patients with type 2 diabetes are more likely to experience fractures. Additionally, lean mass and maybe fat mass may support bone health in people with diabetes. The importance of the marrow microenvironment for effective bone remodeling is becoming increasingly recognized.

The authors wrote, "It is still unclear how warfarin compares to non-vitamin K antagonist oral anticoagulants (NOACs) on incidence fractures among individuals with type 2 diabetes and atrial fibrillation."

15,770 individuals with type 2 diabetes and AF in total (9,288 on NOAC, 6,482 on warfarin) were enrolled in this study. Individuals with type 2 diabetes and AF who began taking warfarin or NOAC between 2005 and 2019 were selected using an electronic database maintained by the Hong Kong Hospital Authority for this retrospective, propensity score-weighted, population-based cohort study. A composite of severe osteoporotic fractures was the main result (hip, clinical vertebral, proximal humerus, and wrist). Cox proportional hazards regression models were used to compute the hazard ratios (HRs).