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Studies on statin use and fracture risk show mixed results

The JAMA Network Journals

CHICAGO - A review of previous studies suggests a possible benefit of statin drugs for reducing the risk of bone fracture in older women, although further research is needed to examine this question, according to an article in the January 26 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, statins are widely used to treat high cholesterol, but little information is available about the effects of statins on bone. Some retrospective studies have found that statin use is associated with a reduced risk for fracture, and other studies suggest that bone mass is higher in people taking statin medications.

Douglas C. Bauer, M.D., from the University of California, San Francisco, and colleagues investigated whether statin use is associated with a reduced risk for bone fracture. The researchers analyzed combined data on statin use and fracture rates from four large prospective studies of older women (the Study of Osteoporotic Fractures, the Fracture Intervention Trial, the Heart and Estrogen/Progestin Replacement Study, and the Rotterdam Study). They also summarized the results of eight observational studies and two clinical trials (found by searching English-language medical literature through January 2002) that reported statin use and documented fractures.

Statin use ranged from less than 1 percent of participants in the Rotterdam Study, to greater than 26 percent in the Heart and Estrogen/Progestin Replacement Study. After the researchers adjusted data to take into account age, body mass index, and estrogen use, they found that there was a trend towards fewer hip fractures (38 percent to 81 percent lower risk) and to a lesser extent, nonspine fractures (5 percent to 51 percent lower risk) among statin users in each of the four large studies. The researchers' analysis of the observational studies was consistent with these findings, with an estimated 57 percent reduction in hip fracture, and an estimated 31 percent reduction in nonspine fracture among statin users. Analysis of the clinical trials did not support a protective effect with statin use for hip or nonspine fracture.

The researchers conclude: "We found that use of [statins] was associated with a consistent and clinically meaningful but nonsignificant reduction in hip and vertebral fracture for prospective observational studies of older women."

"These findings build on the recent reports that statins increase bone formation in rodents and suggest that statins may be useful agents for osteoporosis. Clinical trials are needed to test the ability of potent statins to prevent fracture," write the authors.

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(Arch Intern Med. 2004;164:146-152. Available post-embargo at archinternmed.com)

Editor's Note: This study was supported by grants from the Public Health Service. The Study of Osteoporotic Fractures was supported by grants from the National Institutes of Health, Bethesda, Md. The Fracture Intervention Trial was supported by Merck and Co. The Heart and Estrogen/Progestin Replacement Study was supported by Wyeth. The Rotterdam Study was supported by the Research Institute for Diseases in the Elderly, funded by the Ministry of Education and Science and the Ministry of Health, Welfare and Sports, through the Netherlands Organization for Scientific Research.

To contact Douglas C. Bauer, M.D., call Eve Harris at 415-885-7277.
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

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