American Diabetes Association
DC22-0664 Online-only_supplementary_materials_-_Anticoagulants_and_fracture_risk_in_T2D.docx (129.55 kB)
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Evaluation of fracture risk among type 2 diabetes patients with non-valvular atrial fibrillation receiving different oral anticoagulants

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posted on 2022-09-20, 18:01 authored by David Tak Wai Lui, Eric Ho Man Tang, Ivan Chi Ho Au, Tingting WuTingting Wu, Chi Ho LeeChi Ho Lee, Chun Ka WongChun Ka Wong, Chloe Yu Yan Cheung, Carol Ho Yi Fong, Wing Sun Chow, Yu Cho Woo, Kathryn Choon Beng TanKathryn Choon Beng Tan, Karen Siu Ling Lam, Carlos King Ho WongCarlos King Ho Wong


Objective: Patients with type 2 diabetes are at higher fracture risk owing to the attenuated bone turnover and impaired bone microarchitecture. The comparative effect of warfarin over non-vitamin K antagonist oral anticoagulants (NOACs) on incident fractures among patients with type 2 diabetes comorbid with atrial fibrillation (AF) remains to be elucidated.

Research Design and Methods: This was a retrospective propensity-score weighted population-based cohort study of adults with type 2 diabetes and AF who were started on warfarin or NOAC between 2005 and 2019, identified from the electronic database of the Hong Kong Hospital Authority. The primary outcome was a composite of major osteoporotic fractures (hip, clinical vertebral, proximal humerus and wrist). Hazard ratios (HR) were calculated using Cox proportional hazard regression models.

Results: 15,770 type 2 diabetes patients comorbid with AF were included (9,288 on NOAC and 6,482 on warfarin). During a median follow-up of 20 months, 551 patients (3.5%) sustained major osteoporotic fractures (201 in NOAC group [2.2%]; 350 in warfarin group [5.4%]). The adjusted cumulative incidence was lower among NOAC users than warfarin users (HR 0.80, 95% CI 0.64-0.99, p=0.044). Subgroup analyses showed consistent protective effects against major osteoporotic fractures among NOAC users across sex, age, HbA1c, duration of diabetes and history of severe hypoglycemia, compared with warfarin users. 

Conclusions: NOAC use was associated with a lower risk of major osteoporotic fractures than warfarin use, among type 2 diabetes patients comorbid with AF. NOAC may be the preferred anticoagulant from the perspective of bone health.