Hip fracture risk lower for adults with type 2 diabetes who use statins
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Adults with type 2 diabetes who use statins have a lower risk for hip fracture than those who do not use statins, according to data published in Diabetes/Metabolism Research and Reviews.
“To the best of our knowledge, this is the first population‐based propensity‐matched retrospective cohort study that assessed the effects of statin use on hip fracture risk in patients newly diagnosed with type 2 diabetes,” Mei‐Ling Ho, PhD, professor in the department of physiology at Kaohsiung Medical University in Taiwan, and colleagues wrote. “Our main finding indicated that statin use was associated with decreased risks of hip fractures in patients with type 2 diabetes, demonstrating a dose-effect relationship observed between the cumulative defined daily dose of statins and decreased hip fracture risk.”
Researchers obtained data from the Diabetes Mellitus Health Database of adults with newly diagnosed type 2 diabetes enrolled in the National Health Insurance Research Database in Taiwan. Adults diagnosed with type 2 diabetes between 2010 and 2014 who were prescribed a diabetes medication for 3 months within 1 year of diagnosis were included. Medication codes for all statins available in Taiwan were identified. The cumulative defined daily dose was calculated as the sum of the dispensed defined daily dose since the diabetes diagnosis date for 60 months. Adults with a cumulative defined daily dose of 28 mg or higher were considered statin users, and those with less than 28 mg were nonusers. Propensity score matching by diagnosis year, sex and age was conducted to minimize selection bias between statin users and nonusers. Hip fractures were identified through hospital discharge codes. Follow-up continued until Dec. 31, 2019.
The researchers matched 188,588 adults with type 2 diabetes using statins, 1:1, with adults with type 2 diabetes who did not use statins. The statin group was younger than the nonuser group (mean age, 56.66 years vs. 57.41 years; P < .001).
During follow-up, 1.48% of the statin group and 3.17% of the nonusers sustained a hip fracture. Adults who used statins had a lower risk for hip fractures than nonusers (adjusted HR = 0.47; 95% CI, 0.44-0.5; P < .001). Men were less likely to sustain a fracture than women (aHR = 0.66; 95% CI, 0.62-0.7; P < .001).
Researchers divided statin users into three groups based on cumulative defined daily dose: 28 mg to 174 mg; 175 mg to 447 mg; and more than 447 mg. The 28 mg to 174 mg dose group had a higher risk for hip fracture than the nonuser group (aHR = 1.29; 95% CI, 1.11-1.51; P = .001); however, those with a cumulative defined daily dose of 175 mg to 447 mg (aHR = 0.67; 95% CI, 0.56-0.8; P < .001) or more than 447 mg (aHR = 0.36; 95% CI, 0.28-0.44; P < .001) had a lower risk than the nonuser group.
“Although some studies have identified osteoporosis and fracture risk factors and prevention strategies in patients with type 2 diabetes, the potential of statin use in preventing osteoporosis and related fractures with dose‐effect relationship has not been previously reported,” the researchers wrote. “Based on the high incidence and prevalence of type 2 diabetes and osteoporosis, our findings could contribute to public health implications.”
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