- For patients with Afib, direct oral anticoagulants (DOACs), especially apixaban (Eliquis), are linked to lower fracture risk vs warfarin.
- Comparative effectiveness study finds reduced risk vs warfarin except for hip fracture.
Why this matters
- Warfarin potentially is an adverse risk factor for bone health.
- New users of DOACs vs new users of warfarin had lower risk (adjusted HRs, 95% CIs) for:
- Fracture requiring hospitalization: 0.87 (0.79-0.96).
- Any clinical fracture: 0.93 (0.88-0.98).
- But not significantly lower risk for hip fractures: 0.91 (0.78-1.07).
- Among the DOACs, apixaban was tied to the lowest risk for all comparisons (adjusted HRs, 95% CIs) vs warfarin:
- Fracture requiring hospitalization: 0.60 (0.47-0.78).
- Any clinical fracture: 0.86 (0.75-0.98).
- Hip fracture: 0.67 (0.45-0.98).
- Some hints in subgroup analyses that patients with existing osteoporosis gained greater fracture-related benefit from DOACs (HR, 0.74; 95% CI, 0.58-0.96) vs those without osteoporosis (HR, 1.06; 95% CI, 0.86-1.30).
- MarketScan data analyzed for 167,275 patients with Afib (38.0% women; mean age, 68.9 years) and taking a DOAC (18.9% dabigatran [Pradaxa]; 21.1% rivaroxaban [Xarelto]; 10.6% apixaban) or using warfarin (49.4%).
- Funding: NIH; others.
- Residual confounding possible.
- The DOAC edoxaban (Savaysa) was not included because of too few users.