Statin use, clinical fracture, and bone density in postmenopausal women: results from the Women's Health Initiative Observational Study.
BACKGROUND
3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have been shown to stimulate bone formation in laboratory studies, both in vitro and in vivo. While early epidemiologic studies showed lower risk for hip fracture among statin users than nonusers, subsequent studies have produced mixed results.


OBJECTIVE
To examine the association of statin use with incidence of hip, lower arm or wrist, and other clinical fractures and with baseline levels of bone density.


METHODS
Prospective study.


METHODS
Women's Health Initiative Observational Study conducted in 40 clinical centers in the United States.


METHODS
93 716 postmenopausal women ages 50 to 79 years.


METHODS
Rates of hip, lower arm or wrist, and other clinical fractures were compared among 7846 statin users and 85 870 nonusers over a median follow-up of 3.9 years. In 6442 women enrolled at three clinical centers, baseline levels of total hip, posterior-anterior spine, and total-body bone density measured by using dual-energy x-ray absorptiometry were compared according to statin use.


RESULTS
Age-adjusted rates of hip, lower arm or wrist, and other clinical fractures were similar between statin users and nonusers regardless of duration of statin use. The multivariate-adjusted hazard ratios for current statin use were 1.22 (95% CI, 0.83 to 1.81) for hip fracture, 1.04 (CI, 0.85 to 1.27) for lower arm or wrist fracture, and 1.11 (CI, 1.00 to 1.22) for other clinical fracture. Bone density levels did not statistically differ between statin users and nonusers at any skeletal site after adjustment for age, ethnicity, body mass index, and other factors.


CONCLUSIONS
Statin use did not improve fracture risk or bone density in the Women's Health Initiative Observational Study. The cumulative evidence does not warrant use of statins to prevent or treat osteoporosis.
LaCroix
Andrea Z
AZ
Women's Health Initiative Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, MP-1002, PO Box 19024, Seattle, Washington 98109-1024, USA.
Cauley
Jane A
JA
Pettinger
Mary
M
Hsia
Judith
J
Bauer
Douglas C
DC
McGowan
Joan
J
Chen
Zhao
Z
Lewis
Cora E
CE
McNeeley
S Gene
SG
Passaro
Maureen D
MD
Jackson
Rebecca D
RD
D000368:Aged; D015519:Bone Density / Q000187:drug effects*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D005543:Forearm Injuries / Q000453:epidemiology / Q000517:prevention & control; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control*; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000517:prevention & control; D017698:Postmenopause / Q000502:physiology*; D011446:Prospective Studies; D014954:Wrist Injuries / Q000453:epidemiology / Q000517:prevention & control
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors