The risk for osteoporotic fractures among patients with atrial fibrillation is substantially lower with non-vitamin K oral anticoagulants (NOACs) than with warfarin, an observational study shows.

Researchers from the UK and Hong Kong examined data from the Hong Kong Hospital Authority on more than 23,500 new users of anticoagulants, including 14% treated with apixaban, 29% treated with dabigatran, 16% treated with rivaroxaban and 41% treated with warfarin.

During a median follow-up of nearly 14 months, the weighted rate of osteoporotic fractures per 100 patient-years was 53 with apixaban, 57 with rivaroxaban, 95 with dabigatran and 196 with warfarin, the researchers reported in Annals of Internal Medicine.

At 24 months, the adjusted cumulative incidence of osteoporotic fracture was 1.3% with rivaroxaban, 1.5% with apixaban, 1.6% with dabigatran and 2.4% with warfarin.