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Statin Use May Decrease Bone Fractures

For years, statins (inhibitors of HMG-CoA reductase) have been prescribed widely for cholesterol reduction; however, unexpected noncardiovascular effects now are emerging. Results of animal research have shown that statins increase bone formation, apparently by increasing synthesis of a protein that enhances osteoblast activity. Four groups investigated the relation between statin use and fractures or bone-mineral density.

One group reported on a case-control study performed with data from 91,611 patients in the U.K. Of these patients, 3940 who had suffered bone fractures were each matched with up to 6 controls; matching factors included age, sex, and calendar year of database entry. After adjustment for demographic and clinical factors, current use of statins was associated with a 45 percent lower risk for fracture.

Another case-control study was performed among a large cohort of elderly New Jersey residents. Fracture risk was lower among those who had used statins in the last 180 days (adjusted odds ratio, 0.50) or in the prior 3 years (AOR, 0.57). Other lipid-lowering drugs were not associated with lower fracture rates.

In a third case-control study at 6 U.S. HMOs, 928 women (aged 60 or older) with diagnoses of nonpathologic fractures were identified from automated claims and pharmacy records. Cases were matched with 2747 controls of similar age. Women who had been treated for osteoporosis were excluded. Women to whom statins had been dispensed 13 or more times were found (after adjustment for age and other factors) to have suffered fewer nonpathologic fractures (OR, 0.48) than did women to whom statins had been dispensed 0 to 12 times.

Finally, in a U.K. study, 41 postmenopausal women who took statins for hypercholesterolemia (median treatment period, 4 years) were compared with 100 age-matched controls who did not take statins. The mean bone-mineral density of the statin group (measured at the spine and hip) was significantly higher than that of the controls and remained so even after women receiving hormone replacement therapy were excluded.

Comment: The results of the 3 fracture studies are remarkably consistent, showing roughly 50 percent lower risk for fracture among patients who used statins. Nevertheless, the usual cautions about case-control studies apply, and editorialists suggest that clinicians should not prescribe statins to prevent fractures until prospective clinical trials confirm these findings.

— TH Lee and B Jarman

Published in Journal Watch General Medicine July 11, 2000

Citation(s):

Meier CR et al. HMG-CoA reductase inhibitors and the risk of fractures. JAMA 2000 Jun 28 283 3205-3210.

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• Medline abstract (Free)

Wang PS et al. HMG-CoA reductase inhibitors and the risk of hip fractures in elderly patients. JAMA 2000 Jun 28 283 3211-3216.

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• Medline abstract (Free)

Chan KA et al. Inhibitors of hydroxymethylglutaryl-coenzyme A reductase and risk of fracture among older women. Lancet 2000 Jun 24 355 2185-2188.

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Edwards CJ et al. Oral statins and increased bone-mineral density in postmenopausal women. Lancet 2000 Jun 24 355 2218-2219.

• Medline abstract (Free)

Cummings SR and Bauer DC. Do statins prevent both cardiovascular disease and fracture? JAMA 2000 Jun 28 283 3255-3257.

• Original article (Subscription may be required)
• Medline abstract (Free)

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