Anticoagulants and Osteoporosis

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.

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Osteoporosis and antithrombotic therapy

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4173 ◽

2021 ◽

Vol 26 (5) ◽

pp. 4173

Author(s):

N. V. Brailova ◽

E. N. Dudinskaya ◽

V. A. Kuznesova ◽

O. N. Tkacheva

Keyword(s):

Bone Mineral Density ◽

Bone Metabolism ◽

Bone Tissue ◽

Bone Mineral ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Antiplatelet Agents ◽

Mineral Density ◽

Negative Effect

Anticoagulant and antiplatelet agents are used to prevent stroke and thromboembolic events. There is insufficient data on the effect of these drugs on bone tissue. In addition, the available data are ambiguous, which increases suspicion when used in individuals at high risk of osteoporosis. The article provides data on the effect of anticoagulant and antiplatelet agents on bone metabolism, bone mineral density and the fracture risk. Literature data indicate a negative effect of heparin on bone tissue, which is increase the risk of fractures. Low molecular weight heparins has lower effect on bone tissue than heparin. It is known that vitamin K antagonists significantly affect bone metabolism and markers of bone formation, however, data on the effect on bone mineral density and the risk of fractures are contradictory. Direct oral anticoagulants are relatively safe in relation to bone tissue. Data on the effects of antiplatelet drugs on bone are ambiguous.

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Evolution of bone mineral density, bone metabolism and fragility fractures in Spinal Muscular Atrophy (SMA) types 2 and 3

Neuromuscular Disorders ◽

10.1016/j.nmd.2019.06.001 ◽

2019 ◽

Vol 29 (7) ◽

pp. 525-532 ◽

Cited By ~ 4

Author(s):

Giovanni Baranello ◽

Silvia Vai ◽

Francesca Broggi ◽

Riccardo Masson ◽

Maria Teresa Arnoldi ◽

...

Keyword(s):

Bone Mineral Density ◽

Spinal Muscular Atrophy ◽

Bone Metabolism ◽

Bone Mineral ◽

Muscular Atrophy ◽

Fragility Fractures ◽

Mineral Density

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Intravenous pamidronate for treatment of osteogenesis imperfecta in Indian children

Tropical Doctor ◽

10.1177/0049475520982694 ◽

2021 ◽

pp. 004947552098269

Author(s):

Ira Shah ◽

Akshat Goel ◽

Naman S Shetty ◽

Ashok Johari

Keyword(s):

Bone Mineral Density ◽

Osteogenesis Imperfecta ◽

Bone Mineral ◽

Fragility Fractures ◽

Bone Fragility ◽

Fracture Rate ◽

Spinal Bone Mineral Density ◽

Mineral Density ◽

Indian Children ◽

Intravenous Pamidronate

Osteogenesis imperfecta is characterised by low bone mineral density, bone fragility, fractures and deformity. We present five such children treated with intravenous pamidronate, which resulted in a decrease of fracture rate and increase in spinal bone mineral density.

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Body composition and adipokines influence upon bone mineral density and bone metabolism in renal transplant receivers

Endocrine Abstracts ◽

10.1530/endoabs.70.aep202 ◽

2020 ◽

Author(s):

Anca Matei ◽

Stefana Bilha ◽

Daniela Constantinescu ◽

Petru Cianga ◽

Adrian Covic ◽

...

Keyword(s):

Bone Mineral Density ◽

Body Composition ◽

Renal Transplant ◽

Bone Metabolism ◽

Bone Mineral ◽

Mineral Density

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Review of the Literature Examining the Association of Serum Uric Acid with Osteoporosis and Mechanistic Insights into Its Effect on Bone Metabolism

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530318666181102115106 ◽

2019 ◽

Vol 19 (3) ◽

pp. 259-273 ◽

Cited By ~ 3

Author(s):

Neelam Kaushal ◽

Divya Vohora ◽

Rajinder K Jalali ◽

Sujeet Jha

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Uric Acid ◽

Bone Metabolism ◽

Serum Uric Acid ◽

Bone Mineral ◽

Molecular Mechanisms ◽

Association Studies ◽

Mineral Density ◽

Age Related

Background And Objective:Osteoporosis is a common bone disorder that increases susceptibility to fragility bone fractures. The clinical and public health repercussions of osteoporosis are huge due to the morbidity, mortality, and cost of medical care linked with fragility fractures. Clinical assessment of osteoporotic risk factors can help to identify candidates at an early stage that will benefit from medical intervention and potentially lowering the morbidity and mortality seen with fractures and complications. Given this, research is ongoing to evaluate the association of osteoporosis with some novel or less well-studied risk factors/bio-markers such as uric acid (UA).Discussion:Uric acid’s antioxidant activity has been proposed to be one of the factors responsible for increasing longevity and lowering rates of age-related cancers during primate evolution, the level of which increased markedly due to loss of uricase enzyme activity (mutational silencing). Accumulated evidence shows that oxidative stress is the fundamental mechanism of age-related bone loss and acts via enhancing osteoclastic activity and increasing bone resorption. Antioxidant substances such as ascorbic acid scavenge free radicals are positively related to bone health. Thus, it is hypothesized that uric acid holds bone-protective potential owing to its potent antioxidative property. Several correlation studies have been conducted globally to investigate the relationship between serum uric acid with bone mineral density and osteoporosis. Few pre-clinical studies have tried to investigate the interaction between uric acid and bone mineral density and reported important role played via Runt-related transcription factor 2 (RUNX2)/core-binding factor subunit alpha-1 (CBF-alpha-1), Wingless-related integration site (Wnt)-3a/β-catenin signaling pathway and 11β Hydroxysteroid Dehydrogenase type 1.Conclusion:In this review, the authors provided a comprehensive summary of the literature related to association studies reported in humans as well work done until date to understand the potential cellular and molecular mechanisms that interplay between uric acid and bone metabolism.

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DXA parameters, Trabecular Bone Score (TBS) and Bone Mineral Density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis

Endocrine ◽

10.1007/s12020-021-02806-x ◽

2021 ◽

Author(s):

Enisa Shevroja ◽

Francesco Pio Cafarelli ◽

Giuseppe Guglielmi ◽

Didier Hans

Keyword(s):

Bone Mineral Density ◽

Trabecular Bone ◽

Bone Mineral ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Fragility Fractures ◽

Endocrine Disorders ◽

Mineral Density ◽

Increased Risk

AbstractOsteoporosis, a disease characterized by low bone mass and alterations of bone microarchitecture, leading to an increased risk for fragility fractures and, eventually, to fracture; is associated with an excess of mortality, a decrease in quality of life, and co-morbidities. Bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA), has been the gold standard for the diagnosis of osteoporosis. Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA images, is an index of bone microarchitecture. TBS has been robustly shown to predict fractures independently of BMD. In this review, while reporting also results on BMD, we mainly focus on the TBS role in the assessment of bone health in endocrine disorders known to be reflected in bone.

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