A study of almost 30,000 elderly men published in the September 26 issue of Archives of Internal Medicine suggests that statins, in addition to their lipid-lowering benefit, may also reduce fracture risk.1
Of the 91,052 individuals included in the study, 28,063 were prescribed only statins, 2195 were prescribed nonstatin lipid-lowering medications alone, and the remaining 60,794 were not prescribed any lipid-lowering medications during the study period. In all patients, there was a significant reduction in fractures, with a greater benefit for those in the highest-dose group (>15 mg/day) (odds ratio [OR] .50; 95% confidence interval [CI], .37-.70).
Specifically, patients on statins were 36% (OR .64; 95% CI, 0.58-.72) less likely to sustain a fracture than their counterparts who were not taking any lipid-lowering medications, and 32% (OR .67%; 95% CI, .50-.91) less likely to sustain a fracture than those on nonstatin lipid-lowering therapy.
New findings support the fracture-reduction properties of statins
These findings go along with previous studies that also have found statins to reduce the risk of fractures; however, other studies have not found a benefit. Also, most previous studies consisted of female subjects, according to the new report, who are more susceptible than men to developing brittle bones. As no other statin studies to date have focused on elderly men with heart disease, it was relevant to determine whether men also received bone benefit, since they are the most common users of statins.
The new findings "provide another reason to take [statins], especially [for] patients at low to moderate risk for heart disease," lead investigator Richard E. Scranton, MD, MPH, director of projects at the Massachusetts Veterans Epidemiology Research and Information Center in Boston, Massachusetts, tells CIAOMed. The added benefit of fracture prevention may make this treatment more attractive, especially for primary prevention in women.
"It can be difficult to make the decision to initiate statin therapy in women when talking about primary prevention, as this is a costly way to reduce first myocardial infarction, but if you also consider risk reduction for fracture, the therapy becomes more cost effective," Dr. Scranton says.
Exactly how statins protect against fractures is not known, but several theories exist. "It does appear that the same pathway involved with cholesterol reduction is also involved in bone density, and statins may actually turn on the cells that increase bone density and turn off the cells that break down bone," Dr. Scranton explains.
"We [also] think that by improving cardiovascular disease, vasculature, and endothelial dysfunction, there is better circulation and thus better bone health as well," he says, adding that many of the same risk factors for cardiovascular disease (CVD) are risk factors for fractures. "Reducing CVD burden could promote better bone health," he concludes.
To arrive at their findings, Dr. Scranton and colleagues analyzed the rate of bone fractures in individuals using statins versus those not taking statins among patients who received care in a New England VA healthcare system between January 1, 1998, and June 30, 2001. They culled information on health status, race, age, and body mass index (BMI), as well as other medications that might be associated with bone fracture.
Statins versus other lipid-lowering therapies
According to Dr. Scranton, the comparison between the two groups on cholesterol-lowering drugs is key. Some proponents of statins assert that randomized trials have failed to show a bone benefit for the drugs because the studies compared two groups of patients with similarly high cholesterol levels. And higher cholesterol by itself—or as a marker for higher body weight—may be bone-protective, regardless of statin use. By showing that statin users have fewer fractures even compared with nonstatin users with similar cholesterol and weight profiles, however, the new study validates the view that statins themselves may be the crucial factor.
Fracture-prevention effects of statins questioned
Yet some osteoporosis experts are skeptical about the fracture-prevention effects of statins. "There are reasons to take statins to reduce cholesterol; however, protection against fracture is not an additional advantage that has ever been shown," says CIAOMed editorial board member and osteoporosis editor Nancy E. Lane, MD, professor of medicine and rheumatology at the University of California at Davis Medical Center in Sacramento, California.
Dr. Lane compares the conclusion, based on retrospective studies, that statins lower fracture risk to hormone therapy studies showing a link between estrogen and protection against heart disease. "When retrospective analyses were done on collected data, [estrogen] appeared to protect against heart disease. However, when a prospective randomized controlled trial was done, estrogen not only [was shown to] not help, it increased the risk of heart disease," she tells CIAOMed. "If someone needs to take a bone-active drug, statins are not a substitute at this time," she asserts.
In summary, this study provides supportive information for building the case that statins may protect against fractures. Dr. Scranton agreed with the need for additional studies before recommending their use primarily for reducing the risk of fractures, but added that "given the magnitude of osteoporosis and the consequences of fractures, other drug therapies that could treat this disease would be an important advance."
Reference
- Scranton RE, Young M, Lawler E, Solomon D, Gagnon D, Gaziano M. Statin use and fracture risk. Study of a US veterans population. Arch Intern Med. 2005;165:2007-2012.