Drug-induced Reduction of Gamma Carboxylation in Osteocalcin: What is the Fallback?

Usman, Norina; Qaseem, Aisha; Jayaraj, Joseph S; Fathima, Nida; Janapala, Rajesh Naidu

doi:10.7759/cureus.5504

Cited by 2 publications

(1 citation statement)

References 25 publications

(21 reference statements)

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“…Moreover, the limited vitamin-K intake of patients on VKA treatment may also contribute to lowering vitamin K levels. 33 Vitamin K deficiency can in turn reduce the carboxylated form of osteocalcin, leading to osteoporosis and fragility fracture.…”

Section: Discussionmentioning

confidence: 99%

Risk of fracture in patients with non-valvular atrial fibrillation initiating direct oral anticoagulants vs. vitamin K antagonists

Dell’Aniello

Zhai

et al. 2020

European Heart Journal - Cardiovascular Pharmacotherapy

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Aims To determine the risk of fracture associated with direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in patients with nonvalvular atrial fibrillation (NVAF), accounting for cumulative duration of use. Methods and results Using Quebec administrative healthcare databases, we formed a cohort of all patients aged 40 years or older newly diagnosed with NVAF, who filled a first prescription for DOACs or VKAs between 2011 and 2014. Exposure was modelled as a time-varying variable whereby patients were considered unexposed up to 180 days of cumulative duration of use (to account for a biologically meaningful exposure) and exposed thereafter. The final cohort included 10,306 new users of DOACs and 15,357 new users of VKAs. After propensity score-based fine stratification and weighting, use of DOACs for 180 days or greater was associated with a 35% decreased risk of fracture (crude incidence rates 7.5 vs 15.3 per 1000 person-years; adjusted hazard ratio [HR] 0.65, 95%CI 0.46 - 0.91) compared to VKA duration ≥ 180 days. DOACs use was also associated with a lower risk of hip fracture (HR 0.51, 95%CI 0.31 - 0.86) compared with VKAs. There was no difference in the rate of fracture for shorter duration of use (HR 1.10; 95%CI 0.79 - 1.53). The risk was not modified by age, sex, chronic kidney disease, osteoporosis, history of fracture or falls. Conclusion Prolonged use of DOACs is associated with a lower risk of fracture compared with VKAs. These findings support the first-line recommendation for DOACs in patients with NVAF.

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Section: Discussionmentioning

confidence: 99%