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Statin Use Could Help Reduce Bone Fracture Risk In Older Women

Older women who take statins for hyperlipidaemia could have a lower risk for hip and non-spine fractures, results of 4 large observational studies suggest.

Further research is needed, however, because post-hoc analyses of cardiovascular trials do not demonstrate the lowered risk, say researchers, led by Dr. Douglas Bauer of the University of California at San Francisco, United States.

Use of HMG-CoA reductase inhibitors was associated with "consistent and clinically meaningful but non-significant reduction" in hip and vertebral fractures in 4 prospective observational studies of older women, they explain. No similar trend was seen when non-statin agents were used to lower lipids.

"When these results were quantitatively combined with other studies of statin use and fracture, we observed a significant reduction in hip and non-spine fracture use among statin users," the researchers point out.

They add that clinical trials are needed to test the ability of statins to prevent fracture.

Results from 4 large, prospective studies were analysed. A total of 9,704 non-African women in the United States, older than 65 years, participated in the Study of Osteoporotic Fractures, while the Fracture Intervention Trial looked at 6,459 women, aged 55 to 80 years, recruited from 11 US centres. The Heart and Estrogen/Progestin Replacement Study (HERS) had 2,763 participants aged from 44 to 79 years seen at 20 US centres, and the population-based Rotterdam study included 4,878 Dutch women older than 55 years.

In each study, participants were followed up for fracture occurrence every 4 to 6 months. Investigators classified the women into 1 of 3 mutually exclusive categories by baseline medication use: current statin use, use of non-statin agents to lower lipid levels or no medication use to lower lipid levels.

Statin use ranged from 1% in the Rotterdam study to 26% in the HERS trial.

When the researchers adjusted for factors such as age, body mass index and oestrogen use, they found a trend towards fewer hip fractures (relative hazards [RHs], 0.19 to 0.62) and non-spine fractures (RHs, 0.49 to 0.95) among the women who took statins. But, their meta-analysis of results from 8 observational studies and 2 clinical trials that both reported statin use and documented fracture outcomes did not support a protective effect with statin use for hip fracture or non-spine fracture. The summary odds ratio (OR) found for hip fracture was 0.87; the OR found for non-spine fracture was 1.02.

The researchers concluded: "Controlled trials specifically designed to test the effect of statins on skeletal metabolism and fracture are needed."



Archives of Internal Medicine 2004;164:146-152.

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