Hip fracture risk in statin users?a population-based Danish case-control study

Abstract

Based on animal studies, statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) have been suggested as potential agents in the treatment of osteoporosis. In some epidemiological studies, statins have been associated with a reduced fracture risk. Our objective was to examine associations between statin treatment and risk of hip fracture in a population-based case-control study. A total of 6660 subjects with hip fracture and 33,274 gender- and age-matched population controls were identified from 1 January 1994 to 31 December 2001 using the Hospital Patient Register in North Jutland County, Denmark, and the Danish Central Personal Registry, respectively. Data on redeemed prescriptions for statins within the last 5 years before the index date were retrieved from a population-based prescription database. We used conditional logistic regression to estimate odds ratios (OR) for hip fracture according to use of statin prescriptions adjusted for potential confounding factors, i.e. gender, other diseases, and use of other drugs known to affect bone metabolism and fracture risk. After adjustment for potential confounders, statin treatment was associated with a reduced risk of hip fracture (OR=0.68; 95% confidence interval: 0.50-0.93) for those who had redeemed more than three prescriptions for a statin drug. We found that risk of hip fracture decreased with the number of statin prescriptions. Stratified analyses on gender and age did not reveal any major differences between men and women or among different age groups on the estimates between use of statins and hip fracture risk. Our findings support an association between statin treatment and a reduced hip fracture risk. However, it is unclear whether this association is causal.

Increased Bone Turnover in Patients with Hypercholesterolemia

“…Since Mundy et al [31] published their report on the stimulatory effects of statins on bone formation, numerous clinical studies have evaluated the beneficial effects of statins on BMD [32], fracture risk [32,33] and bone metabolism [26,[34][35][36][37][38]. It remains obscure, however, whether the clinical use of statins has beneficial effects on bone health as well [26], even though their numerous pleiotropic effects are well known.…”

Short-term Effects of Pitavastatin on Biochemical Markers of Bone Turnover in Patients with Hypercholesterolemia

“…Moreover, some clinical studies reported higher bone mineral density (BMD) (17) and lower fracture rates (17,20) in patients treated with statins, but others did not (8,13,21,22). One of the possible reasons for these discrepancies among these clinical studies might be the difference in the statin used (4,5,7,14,23), as some investigators have suggested that its beneficial effects on bone were found only in lipophilic statins, but not hydrophilic ones (4,5,23 (Fig.…”

Depression and osteoporosis: epidemiology and potential mediating pathways

“…Several classes of medications are known to decrease bone mass: glucocorticoids (e.g., for treatment of autoimmune disorders) [75,77], lithium [78], and anti-convulsants [79]. Other medications are known to increase bone mass: estrogen (e.g., postmenopausal hormone replacement therapy) [80], statins [81], and thiazide diuretics [81].…”