title: Statins: under investigation for increasing bone mineral density and augmenting fracture healing.
abstract: BACKGROUND
  Statins are 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase inhibitors and have been shown to possess anti-lipidaemic properties effective in lowering cholesterol. Recent evidence has suggested beneficial pleiotropic effects, including that of fracture healing, alongside its widely accepted ability to reduce the incidence of cardiovascular disease.
  
  
  OBJECTIVE
  A comprehensive review of the recent literature on the effect of statins on bone mineral density and fracture healing.
  
  
  METHODS
  Medline/Ovid and EMBASE search and manual search of bibliography of key papers, on the effects of statins on bone metabolism including in vitro and in vivo studies, as well as clinical trials on the effects of statins on bone mineral density and fracture risk.
  
  
  CONCLUSIONS
  There is robust in vitro and in vivo evidence to suggest the anabolic effects of statins on bone metabolism. Although evidence in patients with osteoporosis is conflicting, several studies have shown that the use of statins is associated with increases in bone mass density and reduction in fracture risk. Conflicting studies identified may be due to different routes of administration, types of statins employed and low doses used. Taken together, there is strong evidence to suggest that statins have beneficial effects on fracture healing that would support further clinical trials investigating such properties.
authors.affiliation: University of Leeds School of Medicine, Leeds General Infirmary Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, Leeds, LS1 3EX, UK.
authors.forename: Quen Oak
authors.initials: QO
authors.lastname: Tang
authors.forename: Gui Tong
authors.initials: GT
authors.lastname: Tran
authors.forename: Zakareya
authors.initials: Z
authors.lastname: Gamie
authors.forename: Simon
authors.initials: S
authors.lastname: Graham
authors.forename: Evaggelos
authors.initials: E
authors.lastname: Tsialogiannis
authors.forename: Evgenios
authors.initials: E
authors.lastname: Tsiridis
authors.forename: Tobias
authors.initials: T
authors.lastname: Linder
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Tsiridis
mesh_terms: D000818:Animals; D000069059:Atorvastatin; D015519:Bone Density / Q000187:drug effects*; D055396:Bone Morphogenetic Protein 2 / Q000235:genetics / Q000502:physiology; D002986:Clinical Trials as Topic; D017102:Fracture Healing / Q000187:drug effects* / Q000502:physiology; D006538:Heptanoic Acids; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D020780:Matrix Metalloproteinase 9 / Q000235:genetics / Q000502:physiology; D010010:Osteoclasts / Q000187:drug effects / Q000502:physiology; D017035:Pravastatin; D011758:Pyrroles; D019821:Simvastatin; D042461:Vascular Endothelial Growth Factor A / Q000235:genetics / Q000502:physiology
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D042461:Vascular Endothelial Growth Factor A; D000069059:Atorvastatin; D019821:Simvastatin; D020780:Matrix Metalloproteinase 9; D017035:Pravastatin