Do Statins Reduce Fractures?

Some studies found a lower risk of fractures in statin users

Four observational studies found that the risk of fractures was approximately half as high in people taking statins as in nonusers (Table 1). At the same time, people taking non-statin lipid-lowering drugs had approximately the same risk as nonusers.

Table 1: Do Statins Decrease Fractures?
Four Studies Say Yes, Four Say No

Studies that found a significantly lower risk

Studies that found no significantly lower risk

*OR odds ratio; HR hazard ratio; numbers in parenthesis are 95% confidence intervals

Together, these findings suggest that the relationship between statin use and decreased fracture risk is causal and related to the biologic activity of statins.

Meier et al,(15) in a case-control study in the United Kingdom, identified 3,940 patients with fractures and matched them with 23,379 subjects without fractures. After controlling for body mass index, smoking, number of physician visits, and use of corticosteroids and estrogen, the odds ratio for fractures among current statin users was 0.55.

Wang et al,(16) in a case-control study in New Jersey Medicaid patients, identified 1,222 patients hospitalized for surgical repair of hip fracture and matched them with 4,888 patients without hip fractures. After controlling for race, health insurance status, ischemic heart disease, cancer, diabetes mellitus, and use of psychoactive medications, estrogen, and thiazides, the odds ratio for hip fractures among current statin users was 0.50.

Chan et al,(17) in a case-control study of women older than 60 years in six US health maintenance organizations, identified 928 patients who sustained a fracture of the hip, humerus, distal tibia, wrist, or vertebra and matched them with 2,747 women without fractures. Women who used anti-osteoporosis drugs were excluded.

Compared with women who did not use statins during the previous 2 years, women with 13 or more statin dispensings during this period had an adjusted odds ratio for fracture of 0.48.

Bauer et al,(18) analyzed data from two large studies of older women: the Study of Osteoporotic Fractures (SOF), with 8,412 women older than 65 years, and the Fracture Intervention Trial (FIT), with 6,459 women ages 55 to 80. At approximately 4 years of follow- up, the adjusted odds ratio for hip fracture in statin users was 0.30, which was not, however, statistically significant.

Other studies found no difference

LaCroix et al,(19) analyzing data from more than 90,000 postmenopausal women, found no link between statin use and risk of hip fractures. However, few women in this study had used statins for more than 3 years. Therefore, the findings do not rule out the possibility that long-term statin use might reduce fracture risk.

Van Staa et al,(20) using the same UK database as Meier et al, identified 81,880 patients with fractures and 81,880 matched controls. Statin users had fracture risks comparable to those using non-statin lipid-lowering agents and untreated hyperlipidemic patients.

Reid et al,(21) analyzed data from the Longterm Intervention with Pravastatin in Ischaemic Disease (LIPID) study, in which 9,014 patients (17% women; median age 62) with ischemic heart disease were randomized to receive either pravastatin 40 mg/day or placebo. After a mean follow-up of 6.1 years, the data did not support a significant effect of statins on fracture risk.

Pedersen and Kjekshus (22) examined the frequency of fractures in the Scandinavian Simvastatin Survival Study (4S), a randomized, double-blind, placebo-controlled, multicenter trial of simvastatin 20 to 40 mg/day in patients aged 35 to 70 with coronary artery disease. Fractures occurred in 155 patients, with no significant difference between the treatment and placebo groups.

Cruz AC, Gruber BL. Statins and Osteoporosis: Can these Lipid-Lowering Drugs also Bolster Bones? Cleve Clin J Med 2002;69:277-278.