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The class of cholesterol-lowering drugs referred to as "statins" are associated with a reduced risk of bone fractures in people age 50 years and older, according to an article in the June 28, 2000, issue of The Journal of the American Medical Association.
Statins have already been shown to be effective in reducing the risk of heart disease in patients with hyperlipidemia. But after adjusting for factors such as body mass index, smoking, and use of corticosteroids and estrogen, the researchers found that patients who were currently using statins also showed a statistically significant reduction in fracture risk compared to patients not using lipid-lowering drugs. The risk of experiencing a fracture was reduced 45 percent for current users of statins, 33 percent for recent users of statins and 13 percent for patients with past exposure to statins.
The researchers also studied use of other types of lipid-lowering drugs to determine whether the reduced risk of bone fracture was specific to statins, but found no association of other lipid-lowering drugs with hip fracture.
Christoph R. Meier, Ph.D., M.Sc., of the University Hospital of Basel in Switzerland, and colleagues analyzed data from the General Practice Research Database (GPRD), a database of 300 practices based in the United Kingdom. The researchers used data collected from the late 1980s until September 1998. The researchers compared patients age 50 through 89 years who had experienced bone fractures (3,940 patients) with patients who had not experienced any fractures (23,379 control patients matched with case patients for age, sex and other characteristics) and examined the use of statins in each group.
"Despite strong evidence from the current analysis, it is necessary to obtain additional information from controlled trials to further investigate possible causal effect of statins on bone fracture risk, and, if an effect exists, further assess the timing of onset of such an effect," the researchers write.
Use of Statins by Elderly Patients Also Associated With Lower Risk of Hip Fracture
There was no statistically significant association for either of these periods for patients using nonstatin lipid-lowering drugs.
Philip S. Wang, M.D., Dr.P.H., of Brigham and Women's Hospital in Boston, and colleagues used data from New Jersey residents 65 years old or older enrolled in Medicare and either Medicaid or the Pharmacy Assistance for the Aged and Disabled program to compare patients who had surgical repair of hip fractures in 1994 (1,222 patients) to control patients (4,888) who had not had surgery. Each case patient was matched to four control patients by age and sex.
"These findings support an association between statin use by elderly patients and reduction in the risk of hip fracture. Controlled trials are needed to exclude the possibility of unmeasured confounders," write the authors.
Citing previous studies, the authors note that "Osteoporosis affects 20 percent of women older than 50 years and an even larger proportion of elderly women; fractures attributable to osteoporosis occur in approximately 1.5 million Americans annually."
Editorial: More study needed before using statins to strengthen older bones
In a JAMA editorial, Steven R. Cummings, M.D., and Douglas C. Bauer, M.D., of the University of California at San Francisco, caution that more research is needed before doctors begin using statins for the particular purpose of reducing risk of bone fractures.
"Recommendations about prescription of statins to prevent fractures must await the results of rigorous randomized trials that are large enough to determine whether currently approved or new statins improve bone mass and reduce the risk of fractures," the doctors write. "In the meantime, patients with osteoporosis should be treated with agents that have been proven to reduce the risk of fractures."