ECTS2016 Poster Presentations Osteoporosis: pathophysiology and epidemiology (55 abstracts)
Warfarin use and changes in bone mineral density in the population-based canadian multicentre osteoporosis study (CaMos)
Nadine Vaninetti 1 , Susan Kirkland 1 , Kara Thompson 1 , Chris Theriault 1 , Jerilynn Prior 2 , Christopher Kovacs 3 , Rick Adachi 4 , Tanveer Towheed 5 , William Leslie 6 , K Shawn Davison 7 , Suzanne Morin 8 , David Goltzman 8 & Stephanie Kaiser 1
1Dalhousie University, Halifax, Nova Scotia, Canada; 2University of British Columbia, Vancouver, British Columbia, Canada; 3Memorial University, Saint John’s, Newfoundland, Canada; 4McMaster University, Hamilton, Ontario, Canada; 5Queens University, Kingston, Ontario, Canada; 6University of Manitoba, Winnipeg, Manitoba, Canada; 7University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 8McGill University, Montreal, Quebec, Canada.
Background: Osteocalcin has an important role in bone metabolism. Uncarboxylated osteocalcin predicts risk for hip fracture and lower bone mineral density (BMD). Warfarin inhibits carboxylation of osteocalcin, providing a mechanistic link between warfarin and impaired bone metabolism. Studies examining the relationship between warfarin use and BMD have been inconsistent. The goal of this study was to further characterize this relationship.
Population: CaMos is a population-based, prospective cohort of the Canadian population followed since recruitment in 1995–1997. Participants (n=4740 female, n=1905 male) underwent BMD testing at L-spine (L1-4), total hip (TH) and femoral neck (FN) and an interviewer-administered questionnaire at years 0, 5 and 10.
Methodology: Cross-sectional analysis of year 0 data examined warfarin users (n=128) and non-users (n=6517). Longitudinal analysis examined the continuous users of warfarin at year 0 and 5. A multivariate linear regression model was used to analyze mean change in BMD in continuous warfarin users vs non users at year 0 to 5, year 5 to 10 and year 0 to 10.
Results: At year 0 there was no significant adjusted difference in BMD among warfarin users (vs non-users) at TH (P=0.064), FN (P=0.755), or L1-4 (P=0.156). Multivariate analysis of continuous warfarin users showed a statistically significant greater decrease in BMD in continuous warfarin users (vs non-users) at years 5 to 10 at TH (−0.013 g/cm2; P=0.029) and FN (−0.012 g/cm2; P=0.035) and at year 0 to 10 at TH (−0.024 g/cm2; P=0.017) and FN (−0.024 g/cm2; P=0.008).
Conclusion: This study demonstrates an association between warfarin use and reduced BMD in continuous warfarin users over a 10-year period. Ongoing longitudinal studies are needed to further clarify the issue of warfarin use and bone metabolism, with focus on fracture rates, and whether long-term warfarin users would benefit from lifestyle or pharmacological interventions for bone protection.
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ISSN 2052-1219 (online)
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