Statins and tendinopathy: a systematic review

Teichtahl, Andrew; Brady, Sharmayne; Urquhart, Donna M.; Wluka, Anita E.; Wang, Yuanyuan; Shaw, Jonathan E.; Cicuttini, Flavia Maria

doi:10.5694/mja15.00806

Cited by 32 publications

(26 citation statements)

References 32 publications

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“…Some other medical treatments, such as the long‐term use of glucocorticoids and aromatase inhibitors, have also been associated with tendinopathy . An increased risk of AT rupture has been reported among patients using statin treatments . However, the reports about statin‐induced tendinopathy are conflicting .…”

Section: Introductionmentioning

confidence: 99%

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Drug treatments associated with Achilles tendon rupture. A case‐control study involving 1118 Achilles tendon ruptures

Nyyssönen

Lantto

Lüthje

et al. 2018

Scandinavian Med Sci Sports

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The incidence of Achilles tendon (AT) rupture, especially nonsport-related rupture, is increasing, while the reasons for this increase are largely unknown. The association between the AT rupture and the use of various drug treatments was studied. We collected AT rupture patients from the Finnish Hospital Discharge Register. We also acquired information about all the doctor-prescribed drugs they had purchased within 1 year before the rupture. For comparison, we randomly selected age- and sex-matched controls from the Finnish Population Register. There were 1118 AT rupture patients. Several drug groups had a statistically significant association with the AT rupture. Our study confirmed an association between fluoroquinolone antibiotics and AT rupture (OR 2.20, P = 0.005). A statistically significant association of renin-angiotensin II receptor antagonists with tendon rupture (OR 7.59, P = 0.003) was a previously unreported finding. The increasing incidence of AT rupture, especially in middle-aged and elderly patients, might partially be a consequence of the increased use of certain drug treatments. Some associations are probably explained by the symptomatic treatment of the painful tendon before the rupture.

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Section: Introductionmentioning

confidence: 99%

“…11 An increased risk of AT rupture has been reported among patients using statin treatments. 12 However, the reports about statin-induced tendinopathy are conflicting. 13,14 The specific pathophysiological mechanisms behind druginduced tendon injury are unknown.…”

Section: Introductionmentioning

confidence: 99%

Drug treatments associated with Achilles tendon rupture. A case‐control study involving 1118 Achilles tendon ruptures

Nyyssönen

Lantto

Lüthje

et al. 2018

Scandinavian Med Sci Sports

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“…Elevated cholesterol levels are commonly managed with statin medication. Interestingly, there appears to be a link between use of these drugs with tendinopathy and tendon rupture (8). It has also been pointed out that those who are prescribed statins have been exposed to high cholesterol levels for a number of years, and this preceding exposure could partly explain the link with the statin medication (5).…”

Section: Dyslipidemiamentioning

confidence: 99%

Does glucocorticoid exposure explain the association between metabolic dysfunction and tendinopathy?

Lewis

Zeisig

Gaida

2020

Endocrine Connections

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Background While metabolic health is acknowledged to affect connective tissue structure and function, the mechanisms are unclear. Glucocorticoids are present in almost every cell type throughout the body and control key physiological processes such as energy homeostasis, stress response, inflammatory and immune processes, and cardiovascular function. Glucocorticoid excess manifests as visceral adiposity, dyslipidemia, insulin resistance, and type 2 diabetes. As these metabolic states are also associated with tendinopathy and tendon rupture, it may be that glucocorticoids excess is the link between metabolic health and tendinopathy. Objective To synthesise current knowledge linking glucocorticoid exposure to tendon structure and function. Methods Narrative literature review. Results We provide an overview of endogenous glucocorticoid production, regulation, and signalling. Next we review the impact that oral glucocorticoid has on risk of tendon rupture and the effect that injected glucocorticoid has on resolution of symptoms. Then we highlight the clinical and mechanistic overlap between tendinopathy and glucocorticoid excess in the areas of visceral adiposity, dyslipidemia, insulin resistance and type 2 diabetes. In these areas, we highlight the role of glucocorticoids and how these hormones might underpin the connection between metabolic health and tendon dysfunction. Conclusions There are several plausible pathways through which glucocorticoids might mediate the connection between metabolic health and tendinopathy.

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“…Some suggest a link between statin treatment and the incidence of tendinopathy and tendon ruptures [8][9][10] , possibly due to an inhibition of type I collagen synthesis 11 . Others have found little to no association between statin therapy and tendinopathy [12][13][14] . There is also some evidence suggesting that statins may have a protective effect against rotator cuff injuries 15 .…”

Section: Introductionmentioning

confidence: 99%

“…There is also some evidence suggesting that statins may have a protective effect against rotator cuff injuries 15 . Interpretation of these results is further complicated by the presence of confounding variables such as diabetes mellitus and hyperuricaemia 14 . Such conditions have also been associated with adverse effects in tendons and makes isolating the influence of statin therapy challenging 14,16 .…”

Section: Introductionmentioning

confidence: 99%

Simvastatin does not adversely affect Achilles tendon properties in a diet induced hypercholesterolemia rat model

Choi

Shentye

Tucker

et al. 2019

Muscle Ligaments and Tendons J

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Introduction: Hypercholesterolemia affects a third of adults in the United States and is commonly managed with statins. While statins provide proven cardiovascular benefits, their effect on the musculoskeletal system has been understudied. The purpose of this study was to investigate the effects of statins on Achilles tendons of diet induced hypercholesterolemic rats. Methods: Thirty adult male Sprague-Dawley rats were assigned to three groups: control (CTL, n=10), high cholesterol (HC, n = 10), and high cholesterol with statin (HC+S, n = 10). CTL was fed normal chow, while HC and HC+S were fed high cholesterol chow. HC+S received simvastatin during the final 3 months, with all animals sacrificed 9 months after the study was initiated, followed by biomechanical testing and histological analysis. Results: HC Achilles demonstrated increased stiffness as compared to both CTL and HC+S. Histological analysis revealed trends toward increased cellularity in HC as compared to both CTL and HC+S. Both stiffness and cellularity exhibited a potential return to baseline effect with statin treatment, with no differences observed between CTL and HC+S.Conclusions: While we were unable to determine conclusive therapeutic effects of statins, results support that statins may not have detrimental effects on Achilles tendon health when prescribed to hypercholesterolemic individuals. Level of Evidence: Not applicable, this is a basic science study.

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Statins and tendinopathy: a systematic review

Abstract: To date, there is a paucity of evidence to implicate statin therapy as a well established risk factor or causal mechanism for tendon rupture in the general population. There is strong evidence that simvastatin reduces the risk of tendinopathy.

Cited by 32 publications

References 32 publications

Drug treatments associated with Achilles tendon rupture. A case‐control study involving 1118 Achilles tendon ruptures

Drug treatments associated with Achilles tendon rupture. A case‐control study involving 1118 Achilles tendon ruptures

Does glucocorticoid exposure explain the association between metabolic dysfunction and tendinopathy?

Simvastatin does not adversely affect Achilles tendon properties in a diet induced hypercholesterolemia rat model

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