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).

Key highlights of the study:

• 551 individuals (3.5%) suffered significant osteoporotic fractures throughout a 20-month median follow-up period (201 [2.2%] in the NOAC group and 350 [5.4%] in the warfarin group).
• Users of NOACs had a lower adjusted cumulative incidence than those on warfarin (HR 0.80; 95% CI 0.64, 0.99; P = 0.044).
• Comparing NOAC users to warfarin users, subgroup analyses revealed that NOAC users consistently exhibited protective effects against significant osteoporotic fractures regardless of sex, age, HbA1c, length of diabetes, or history of severe hypoglycemia.

Because they are linked to a lower incidence of severe osteoporotic fractures, the researchers came to the conclusion that non-vitamin K antagonist oral anticoagulants may be the best anticoagulants from the perspective of bone health.

REFERENCE

David Tak Wai Lui, Eric Ho Man Tang, Ivan Chi Ho Au, Tingting Wu, Chi Ho Lee, Chun Ka Wong, Chloe Yu Yan Cheung, Carol Ho Yi Fong, Wing Sun Chow, Yu Cho Woo, Kathryn Choon Beng Tan, Karen Siu Ling Lam, Carlos King Ho Wong; Evaluation of Fracture Risk Among Patients With Type 2 Diabetes and Nonvalvular Atrial Fibrillation Receiving Different Oral Anticoagulants. Diabetes Care 2022; dc220664. https://doi.org/10.2337/dc22-0664