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The Association of Warfarin Use With Osteoporotic Fracture in Elderly Patients With Atrial Fibrillation—Reply
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In reply
We agree that in trials of warfarin for atrial fibrillation, elderly patients at high risk for falls were excluded, and thus there is relatively little evidence on which to base decision making for these patients. In our retrospective cohort, the adjusted odds ratio of osteoporotic fractures was 1.25 in Medicare beneficiaries prescribed long-term warfarin therapy, representing a 25% increase in relative risk. In our prospective cohort, the increase in relative risk was slightly larger (32%).
Thus, we agree that the benefit of warfarin to prevent strokes should be balanced against the risks of adverse events. These risks depend on comorbid conditions and age.1 For example, in our data set, the adjusted absolute increase (95% confidence interval) was 1.5 (0.6-2.2) incident fractures per 100 patient-years of long-term warfarin therapy in patients 80 years or older. This absolute increase (95% confidence interval) was lower in younger Medicare beneficiaries: 0.9 (0.4-1.4) . . . [Full Text of this Article]
AUTHOR INFORMATION
Brian F. Gage, MD, MSc;
Elena Birman-Deych, MS;
Martha J. Radford, MD
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