Institute of Virology and AIDS Research, First Hospital of Jilin University, Jilin University, Changchun, China.
Department of Orthopedics, Orthopedics Center, First Hospital of Jilin University, Jilin University, Changchun, China.
Front Endocrinol (Lausanne). 2023 Sep 29;14:1212570. doi: 10.3389/fendo.2023.1212570. eCollection 2023.
Evidence on the association between the risk of new-onset osteoporosis and oral anticoagulants remains controversial. We aimed to compare the risk of osteoporosis associated with the use of direct oral anticoagulants (DOACs) with that associated with warfarin use.
Studies published up to 15 March 2023 that investigated the association between the use of DOACs and warfarin and the incidence of osteoporosis were identified by online searches in PubMed, Embase, the Cochrane Library, and Web of Science conducted by two independent investigators. Random-effects or fixed-effect models were employed to synthesize hazard ratios (HRs)/relative ratios (RRs) with 95% confidence intervals (CIs) for estimating the risk of osteoporosis correlated with DOAC and warfarin prescriptions (PROSPERO No. CRD42023401199).
Our meta-analysis ultimately included four studies involving 74,338 patients. The results suggested that DOAC use was associated with a significantly lower incidence of new-onset osteoporosis than warfarin use (pooled HR: 0.71, 95% CI: 0.57 to 0.88, < 0.001, : 85.1%). Subanalyses revealed that rivaroxaban was associated with a lower risk of osteoporosis than both warfarin and dabigatran. In addition, DOACs were associated with a lower risk of developing osteoporosis than warfarin in both male and female patients, in patients with atrial fibrillation (AF), and in patients who underwent therapy for > 365 days.
DOAC users experienced a lower incidence of osteoporosis than warfarin users. This study may give us insight into safe anticoagulation strategies for patients who are at high risk of developing osteoporosis.
https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023401199.
关于新型骨质疏松症风险与口服抗凝剂之间关联的证据仍存在争议。本研究旨在比较直接口服抗凝剂（DOAC）与华法林使用相关的骨质疏松症风险。
通过两位独立研究者在线检索 PubMed、Embase、Cochrane 图书馆和 Web of Science，检索截至 2023 年 3 月 15 日发表的研究，以评估 DOAC 和华法林的使用与骨质疏松症发病之间的关联。采用随机效应或固定效应模型合成风险比（HR）/相对比值（RR）及其 95%置信区间（CI），以评估与 DOAC 和华法林处方相关的骨质疏松症风险（PROSPERO 编号：CRD42023401199）。
本荟萃分析最终纳入了四项共涉及 74338 例患者的研究。结果表明，与华法林相比，DOAC 使用与新发骨质疏松症的发生率显著降低相关（汇总 HR：0.71，95%CI：0.57 至 0.88， < 0.001， = 85.1%）。亚组分析显示，与华法林和达比加群相比，利伐沙班与骨质疏松症风险降低相关。此外，在男性和女性患者、心房颤动（AF）患者以及接受治疗>365 天的患者中，与华法林相比，DOAC 也与较低的骨质疏松症发病风险相关。
与华法林使用者相比，DOAC 使用者骨质疏松症的发生率较低。本研究可能为骨质疏松症高危患者的安全抗凝策略提供了新的见解。
https://www.crd.york.ac.uk/PROSPERO，注册号 CRD42023401199。
