HMG-CoA reductase inhibitors and the risk of vertebral fracture.
Statins inhibit an enzyme in the mevalonate pathway and therefore may affect bone. In this first study on both symptomatic and nonsymptomatic vertebral fractures in the elderly (N = 3469), we show that long-term statin use is significantly associated with a 50% lower vertebral fracture risk. Randomized trials on statins and fractures, carried out in populations at risk for fractures, are needed.


BACKGROUND
Statins are cholesterol-lowering agents that could potentially affect bone. Previous studies on statin use and fracture risk reported contradictory results and did not include both symptomatic and nonsymptomatic vertebral fractures.


METHODS
To examine the association between statin use, vertebral fractures, and lumbar spine BMD, we performed a prospective population-based cohort study in men and women (N = 3469) > or =55 years of age. These individuals had both baseline and follow-up spinal X-rays available. Statin use was obtained from detailed computerized pharmacy data, and the total number of days of exposure before second X-ray was calculated. A multivariate logistic regression model was fitted to calculate odds ratios and CIs.


RESULTS
During a mean follow-up of 6.5 years, 176 incident vertebral fractures occurred. There were 508 statin users and 16 exposed cases. The adjusted relative risk for incident vertebral fracture in users of statins (compared with nonusers) was 0.58 (95% CI, 0.34-0.99). The relative risk decreased on higher cumulative use to 0.52 (95% CI, 0.28-0.97) for use for more than 365 days during the study period. Use of (the hydrophilic statin) pravastatin and use of nonstatin cholesterol-lowering drugs was not significantly associated with vertebral fracture risk. Statin use was not significantly associated with lumbar spine BMD.


CONCLUSIONS
Statin use is associated with a lower risk of vertebral fracture. Randomized clinical trials in a population at risk for fracture are needed to examine this association.
Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam 3000 DR, The Netherlands.
Mariette W C J
MW
Schoofs
Miriam C J M
MC
Sturkenboom
Marjolein
M
van der Klift
Albert
A
Hofman
Huibert A P
HA
Pols
Bruno H Ch
BH
Stricker
D000368:Aged; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D015331:Cohort Studies; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000502:physiology; D008297:Male; D008875:Middle Aged; D017035:Pravastatin / Q000008:administration & dosage / Q000494:pharmacology; D012306:Risk; D016103:Spinal Fractures / Q000503:physiopathology / Q000517:prevention & control*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin