Warfarin use and fracture risk: an evidence-based mechanistic insight

Something for your doctor to maybe warn you about.
http://link.springer.com/article/10.1007/s00198-014-2912-1

This is an excerpt from the content

Dear Editor,

There is a long-standing debate on the association between use of warfarin, prescribed to millions of people to decrease their risk of clotting, and fracture risk [1]. In a large population-based cohort in the UK, Misra and colleagues [2] found that warfarin use was not linked to an increase in fracture risk. Here, we would like to present an evidence-based, reasonable insight into the mechanisms by which this drug affects bone strength.

Osteocalcin, the most abundant non-collagenous protein in bone, is incorporated into bone through vitamin K-dependent γ-carboxylation. Warfarin, a vitamin K antagonist, decreases osteocalcin content in bone and impairs bone material hardness in rats [3], which is consistent with data in mice that osteocalcin deficiency causes a decrease in bone tissue hardness [4]. Consistently, in older patients undergoing chronic therapy with oral vitamin K antagonists [5], undercarboxylated osteocalcin levels in blood were inversely related to cortical ul ...