[Secondary osteoporosis induced by anticoagulants?].
Generalized osteoporosis is a result of different causes and pathogenic mechanisms, which often combine forces to become clinically relevant. Among the different exogenic factors, drugs play an important role, frequently in connection with other factors such as immobilization or pregnancy. It has been suggested that anticoagulation therapy with heparins or coumarins may induce osteoporotic changes or enhance the development of osteoporosis for other reasons. According to in vitro experiments, preclinical trials, and clinical investigations, it seems reasonable to assume that heparins induce increased bone loss in a time- and dose-related manner. Low-molecular-weight heparins most likely have less effect on bone turnover when compared to unfractionated heparin. Oral anticoagulation therapy with vitamin K-antagonists is believed to have a weak effect on induction of osteoporosis, but clinical studies are contradictory. In spite of the fact that a relevant effect of these drugs on the induction of osteoporosis is questionable, it must be taken into consideration that anticoagulant drugs may enhance the negative effects on bone density of other risk factors capable of inducing osteoporosis such as immobilization, pregnancy, or endocrinological disorders.
Riess
H
H
Medizinische Klinik und Poliklinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Campus Virchow-Klinikum, Medizinische Fakultät, Humboldt-Universität, Augustenburger Platz 1, 13353 Berlin. hanno.riess@charite.de
Loew
A
A
Himmelreich
G
G
D000284:Administration, Oral; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D015519:Bone Density; D001842:Bone and Bones / Q000378:metabolism; D002986:Clinical Trials as Topic; D003374:Coumarins / Q000008:administration & dosage / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000209:etiology; D015663:Osteoporosis, Postmenopausal / Q000139:chemically induced / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000378:metabolism
D000925:Anticoagulants; D003374:Coumarins; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K; D006493:Heparin; C030123:coumarin
Sekundäre Osteoporose durch Antikoagulantien?