Ticagrelor was associated with lower fracture risk than clopidogrel in the dual anti-platelet regimen among patients with acute coronary syndrome treated with percutaneous coronary intervention

Ticagrelor was associated with lower fracture risk than clopidogrel in the dual anti-platelet regimen among patients with acute coronary syndrome treated with percutaneous coronary intervention J Endocrinol Invest. 2024 Apr;47(4):895-902. doi: 10.1007/s40618-023-02205-1 Abstract Purpose: Patients with coronary artery disease have increased fracture risks. P2Y12 inhibitors may impact fracture risks. We compared the fracture risks associated with ticagrelor and clopidogrel in dual anti-platelet therapy (DAPT).   Methods: We identified all adults who underwent first-ever percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) between 2010 and 2017 from a territory-wide PCI registry in Hong Kong. Following 1:1 propensity-score matching for baseline characteristics, patients were followed up till event occurrence, death, or 30 June 2022. Outcomes of interest were major osteoporotic fractures (MOF) identified by validated ICD-9-CM codes. Cox proportional hazards regression was used to compute the hazard ratio (HR) for major osteoporotic fractures associated with ticagrelor versus clopidogrel use.   Results: 3018 ticagrelor users and 3018 clopidogrel users were identified after propensity-score matching (mean age: 61.4 years; 84.1% men). Upon median follow-up of 6.5 years, 59 ticagrelor users and 119 clopidogrel users sustained major osteoporotic fractures (annualized fracture risks: 0.34 % and 0.56%, respectively). Ticagrelor use was associated with lower risks of major osteoporotic fractures (HR 0.60, 95%CI 0.44-0.83; p = 0.002). Consistent hazard ratios were observed for fractures over vertebrae, hip and upper limbs. Subgroup analyses showed no interaction according to age, sex, presence of diabetes, presence of chronic kidney disease and prior fracture history.  Conclusion: Among adults who underwent first-ever percutaneous coronary intervention for acute coronary syndrome, ticagrelor use in the dual anti-platelet therapy was associated with a lower risk of major osteoporotic fractures compared with clopidogrel. Our results support the use of ticagrelor in the dual anti-platelet therapy from the perspective of bone health. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website