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Incident long-term warfarin use and risk of osteoporotic fractures: propensity-score matched cohort of elders with new onset atrial fibrillation

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Abstract

Summary

Association between warfarin use and fracture risk is unclear. We examined the association between long-term warfarin use and fracture risk at the hip, spine, and wrist in elders. No significant association was found between long-term warfarin use and fracture risk, despite biological plausibility.

Introduction

Prior studies examining the association of warfarin use and osteoporotic fractures have been conflicting, potentially related to methodological limitations. Thus, we examined the association of long-term warfarin use with risk of hip, spine, and wrist fractures among older adults with atrial fibrillation, attempting to address prior methodologic challenges.

Methods

We included men and women ≥65 years of age with incident atrial fibrillation and without prior history of fractures from The Health Improvement Network followed between 2000 and 2010. Long-term warfarin use was defined in two ways: (1) warfarin use ≥1 year; (2) warfarin use ≥3 years. Propensity-score matched cohorts of warfarin users and nonusers were created to evaluate the association between long-term warfarin use and risk of hip, spine, and wrist fractures separately as well as combined, using Cox-proportional hazards regression models.

Results

Among >20,000 participants with incident atrial fibrillation, the hazard ratios (HR) for hip fracture with warfarin use ≥1 and ≥3 years, respectively, were 1.08 (95%CI 0.87, 1.35) and 1.13 (95 % CI 0.84, 1.50). Similarly, no significant associations were observed between long-term warfarin use and risk of spine or wrist fracture. When risk of any fracture was assessed with warfarin use, no association was found [HR for warfarin use ≥1 year 0.92 (95%CI 0.77, 1.10); HR for warfarin use ≥3 years 1.12 (95%CI 0.88, 1.43)].

Conclusions

Long-term warfarin use among elders with atrial fibrillation was not associated with increased risk of osteoporotic fractures and therefore does not appear to necessitate additional surveillance or prophylaxis.

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Conflicts of interest

Dr. Kiel received grant support from Amgen, Eli Lilly, and Merck Sharp & Dohme, and serves on scientific advisory boards for Amgen, Eli Lilly, Merck Sharp and Dohme, Novartis, and Ammonett Pharma. All other authors state that they have no conflicts of interest.

Support

D. Misra is supported by the Arthritis Foundation Postdoctoral Fellowship Award and Rheumatology Research Foundation Investigator Award. T. Neogi is supported by NIAMS K23 AR055127 and 1R01AR062506-01A1. This work was also supported by NIH P60AR047785-11-6150. Dr. Kiel is supported by a grant from NIAMS R01 AR/AG 41398.

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Authors and Affiliations

  1. Boston University School of Medicine, 650 Albany St, Suite X-200, Clinical Epidemiology Unit, Boston, MA, 02118, USA

    D. Misra, Y. Zhang, C. Peloquin, H. K. Choi & T. Neogi

  2. Boston University School of Public Health, Boston, MA, USA

    Y. Zhang

  3. Hebrew SeniorLife, Institute for Aging Research, Harvard Medical School, Boston, MA, USA

    D. P. Kiel

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  1. D. Misra
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  2. Y. Zhang
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  6. T. Neogi
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Correspondence to D. Misra.

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Misra, D., Zhang, Y., Peloquin, C. et al. Incident long-term warfarin use and risk of osteoporotic fractures: propensity-score matched cohort of elders with new onset atrial fibrillation. Osteoporos Int 25, 1677–1684 (2014). https://doi.org/10.1007/s00198-014-2662-0

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  • DOI: https://doi.org/10.1007/s00198-014-2662-0

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