Bone Metabolism Markers and Bone Mineral Density in Patients on Long-Term Acenocoumarol Treatment: A Cross-Sectional Study

Abstract

The aim of this study was to evaluate levels of osteocalcin (OC), osteoprotegerin (OPG) and total soluble receptor activator of nuclear factor-κB ligand (RANKL), and bone mineral density (BMD) in patients on long-term acenocoumarol (AC) treatment. The cross-sectional study was carried out in 42 patients treated long-term with AC and 28 control subjects. Serum concentrations of OC, OPG, and sRANKL were measured using enzyme linked immunosorbent assay (ELISA) kits, and BMD at the femoral neck and lumbar spine were assessed by dual energy X-ray absorptiometry. A significantly decreased concentration of OC was found in AC users compared to control subjects (4.94 ± 2.22 vs. 10.68 ± 4.5; p < 0.001). Levels of OPG, sRANKL logarithm (log), sRANKL/OPG log ratio, and BMD were comparable between. In female AC users, positive correlations between OC and RANKL log, and between OC and RANKL/OPG log ratio (p = 0.017; p = 0.005, respectively), and a negative correlation between OC and OPG (p = 0.027) were found. Long-term AC anticoagulation significantly decreases OC concentration, but does not affect other bone metabolism markers or BMD. Our results also suggest the possibility that long-term treatment with AC may alleviate bone resorption in postmenopausal women.

Keywords: acenocoumarol; bone metabolism; bone mineral density; osteocalcin; vitamin K antagonists.

Figure 1

Levels of sRANKL/OPG log ratio in female and male controls, and female and male AC users. sRANKL, soluble receptor activator of nuclear factor-κB ligand; log, logarithm; AC, acenocoumarol; OPG, osteoprotegerin.

Figure 2

A positive correlation between concentration of osteocalcin (OC) and soluble receptor activator of nuclear factor-κB ligand (sRANKL)/osteoprotegerin (OPG) logarithm (log) ratio in female acenocoumarol (AC) users.