Statins: under investigation for increasing bone mineral density and augmenting fracture healing.
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.
Tang
Quen Oak
QO
University of Leeds School of Medicine, Leeds General Infirmary Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, Leeds, LS1 3EX, UK.
Tran
Gui Tong
GT
Gamie
Zakareya
Z
Graham
Simon
S
Tsialogiannis
Evaggelos
E
Tsiridis
Evgenios
E
Linder
Tobias
T
Tsiridis
Eleftherios
E
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
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