Journal of General Internal Medicine

, Volume 35, Issue 1, pp 396–397 | Cite as

Vitamin K Antagonist Use and Fracture

  • Wallis C. Y. LauEmail author
  • Kenneth K. C. Man
  • Ian C. K. Wong
Letter to the Editor

We read with interest the article by Fiordellisi and colleagues, who reported findings of a systematic review and meta-analysis on the association between vitamin K antagonist (VKA) use and fracture.1 The results provide an important contribution to better understand the risk of fractures associated with VKA use, which is still controversial and not well described in clinical practice.

One of the key findings of Fiordellisi et al. was that there was no association between a higher risk of fracture and the use of VKA versus non-vitamin K antagonist oral anticoagulant (NOAC). The finding was supported by a pooled estimate of 0.95 (95% confidence interval 0.78–1.15) with respect to VKA versus NOAC users. In reviewing this finding, we looked at the data presented in the forest plot (Figure 3 in the article). We found that the data for three of the included studies: Lucenteforte et al., 2 Norby et al., 3 and Steffel et al., 4 matched with the adjusted hazard ratios of NOAC versus VKA users...


Compliance with Ethical Standards

Conflict of Interest

ICKW has received research funding outside the submitted work from the Hong Kong Research Grants Council, the Hong Kong Health and Medical Research Fund, Bristol-Myers Squibb, Pfizer, Janssen, and Bayer; KKCM is supported by the CW Maplethorpe Fellowship and has received personal fees outside the submitted work from IQVIA Holdings. No other disclosures were reported.


  1. 1.
    Fiordellisi W, White K, Schweizer M. A Systematic Review and Meta-analysis of the Association Between Vitamin K Antagonist Use and Fracture. J Gen Intern Med. 2018. CrossRefGoogle Scholar
  2. 2.
    Lucenteforte E, Bettiol A, Lombardi N, Mugelli A, Vannacci A. Risk of bone fractures among users of oral anticoagulants: An administrative database cohort study. Eur J Intern Med. 2017;44:e30-e1.CrossRefGoogle Scholar
  3. 3.
    Norby FL, Bengtson LGS, Lutsey PL, Chen LY, MacLehose RF, Chamberlain AM, et al. Comparative effectiveness of rivaroxaban versus warfarin or dabigatran for the treatment of patients with non-valvular atrial fibrillation. BMC Cardiovasc Disord. 2017;17(1).Google Scholar
  4. 4.
    Steffel J, Giugliano RP, Braunwald E, Murphy SA, Mercuri M, Choi Y, et al. Edoxaban Versus Warfarin in Atrial Fibrillation Patients at Risk of Falling: ENGAGE AF-TIMI 48 Analysis. J Am Coll Cardiol. 2016;68(11):1169–78.CrossRefGoogle Scholar
  5. 5.
    Lau WC, Chan EW, Cheung CL, Sing CW, Man KK, Lip GY, et al. Association Between Dabigatran vs Warfarin and Risk of Osteoporotic Fractures Among Patients With Nonvalvular Atrial Fibrillation. JAMA. 2017;317(11):1151–8.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Wallis C. Y. Lau
    • 1
    • 2
    Email author
  • Kenneth K. C. Man
    • 1
    • 2
  • Ian C. K. Wong
    • 1
    • 2
  1. 1.Research Department of Practice and PolicyUCL School of PharmacyLondonUK
  2. 2.Centre for Safe Medication and Practice Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of MedicineThe University of Hong KongPok Fu LamHong Kong

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