Statin use associated with lower fracture risk

Patients treated with higher statin doses seemed to have a greater fracture risk reduction compared to patients on lower doses.

A large study involving elderly, predominately male veterans found that patients treated with statins had a 36% lower fracture risk than those not receiving lipid-lowering therapy.

Previous studies have shown an association between statin use and reduced fracture risk. However, those studies involved mostly women, while most statin users are elderly men with heart disease.

Several biological mechanisms have been proposed to explain the association between statins and bone health, including reduced inflammation and promotion of new bone growth through improvements in small blood vessel function. But the mechanism of action remains uncertain, according to the study, published in Archives of Internal Medicine.

Richard E. Scranton, MD, MPH, and colleagues at the Massachusetts Veterans Epidemiology Research and Information Center in Boston, retrospectively reviewed records for all patients treated in the New England VA health system between January 1998 and June 2001. After excluding patients for several reasons, the final data analysis involved 91,052 patients (86,731 men and 4321 women) who received more than one prescription for any statin medication, any non-statin lipid-lowering medication, or neither a statin nor a non-statin medication.

The researchers included data on patients’ health status, race, age and body mass index (BMI) as well as use of other medications that might be associated with fractures. Of the 91,052 patients, 28,063 were treated with statins only and 2195 were treated with non-statin lipid-lowering medications only. The remaining 60,794 patients were not prescribed any lipid-lowering medications during the study period.

The researchers found that statin-treated patients were significantly older than non-statin-treated patients as well as patients not receiving either drug type (untreated patients). Statin users had a mean age of 65.1 years compared to 59.3 years for untreated patients (P<.001) and 61 years for non-statin-treated patients (P<.001), according to the study.

Statin-treated patients had significantly fewer fractures during the study period, presenting a total of 394 fractures. In comparison, untreated patients had a total of 2018 fractures and non-statin-treated patients had 51 fractures. This yields a fracture incidence rate of 7 per 1000 person-years among statin-treated patients compared to a rate of 11.3 for non-statin-treated patients and 12.2 for untreated patients, according to the study.

Non-statin-treated patients also tended to have higher BMI and higher mean Charlston Comorbidity Index scores. Cormorbidity Index scores averaged 1.4 for non-statin-treated patients, 1.3 for statin-treated patients and 0.9 for untreated patients, the authors noted.

“The use of statins in this study was associated with a 36% reduction in fracture risk when compared with no lipid-lowering therapy and a 32% risk reduction when compared with other lipid-lowering therapy,” the authors said in the study. “These findings did not deviate significantly after adjustment for various covariates, including BMI,” they said.

“In all models there is a significant reduction in the risk of fractures, with a greater benefit for those in the upper tertile of statin dose,” they added.

The study was supported by grants from the National Institutes of Health, the Arthritis Foundation and the Department of Veterans Affairs.

For more information:
Scranton RE, Young M, Lawler E, et al. Statin use and fracture risk. Arch Intern Med. 2005;165:2007-2012.