Abstract
Background: Recent reports indicate that HMG-CoA reductase inhibitors (statins), used for prevention and treatment of dyslipidemia and CVD, might have a beneficial effect on bone metabolism. Limitations of previous studies do not allow unequivocal conclusions about bone-sparing effect of statins.
Methods: This study examined statin use and osteoporosis-related skeletal fractures. Members of a large New Mexico Health Plan served as the study population (n=7,539). The sample included women > 50 years old and men > 60 years old who had > 1 prescription fill or > 1 encounter with a healthcare provider between 1999 and 2005, but excluded patients with cancer, osteomalacia, and end stage renal disease. Patients with incident fractures of the hip, wrist/forearm, and spine occurring between 1999 and 2005 were identified as cases (n=1,880). Controls were selected from the same population based on timing of enrollment to controls in 1:3 ratio (n=5,659). The prevalence of statin use (> 3 fills a year prior to the index date) was compared among study groups by Chi-square analysis in univariate and by logistic regression in multivariate analyses. To explore duration -response effect, statin use was classified as current (3 months prior to the index date) and continuous (> 10 annual fills prior to the index date).
Results: The mean age was 71.4±10.2 years among cases and 63.8±9.2 among controls, with 72.8% females. 15.9% of cases and 17.1% of controls reported any statin use, and the most prevalent statins were simvastatin followed by lovastatin, atorvastatin, and pravastatin. In men, no association between fractures and either current (OR=0.81; 95% CI: 0.55; 1.20) or continuous statin use (OR=0.86; 95% CI: 0.51; 1.44) was observed after adjustment for age, corticosteroids use, chronic kidney disease, and comorbidities. In women, significant protective effect was observed among both current (OR=0.58; 95% CI: 0.44; 0.78) and continuous (OR=0.66; 95% CI: 0.45; 0.99) statin users independent of age, corticosteroid use, bisphosphonates, chronic kidney disease, comorbidities, and postmenopausal hormone therapy.
Conclusions: We observed a protective effect of statins on osteoporosis- related fractures in women but not in men. These findings suggest sex- specific effect of statins on bone metabolism.
