Risk of Osteoporotic Fracture in Elderly Patients Taking Warfarin

Abstract
Warfarin and other vitamin K antagonists are prescribed to millions of people worldwide to decrease their risk of clotting. These drugs work by interfering with the γ-carboxylation of glutamic acid (Glu) residues on clotting factors II, VII, IX, and X. Because γ-carboxylation of specific Glu residues is also required for activation of osteocalcin and other bone matrix proteins,1 vitamin K antagonists might increase the risk of osteoporotic fractures. Evidence for this hypothesis comes from experimental studies of rats, which found that therapeutic use of warfarin decreases the rate of bone formation and increases the rate of bone resorption in the rat femur, resulting in decreased femoral bone strength.

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