title: Statins and hip fracture prevention--a population based cohort study in women.
abstract: OBJECTIVE
  To study the association of long-term statin use and the risk of low-energy hip fractures in middle-aged and elderly women.
  
  
  METHODS
  A register-based cohort study.
  
  
  METHODS
  Finland.
  
  
  METHODS
  Women aged 45-75 years initiating statin therapy between 1996 and 2001 with adherence to statins ≥ 80% during the subsequent five years (n = 40,254), a respective cohort initiating hypertension drugs (n = 41 610), and women randomly selected from the population (n = 62 585).
  
  
  METHODS
  Incidence rate of and hazard ratio (HR) for low-energy hip fracture during the follow-up extending up to 7 years after the 5-year exposure period.
  
  
  RESULTS
  Altogether 199 low-energy hip fractures occurred during the 135 330 person-years (py) of follow-up in the statin cohort, giving an incidence rate of 1.5 hip fractures per 1000 py. In the hypertension and the population cohorts, the rates were 2.0 per 1000 py (312 fractures per 157,090 py) and 1.0 per 1000 py (212 fractures per 216 329 py), respectively. Adjusting for a propensity score and individual variables strongly predicting the outcome, good adherence to statins for five years was associated with a 29% decreased risk (HR 0.71; 95% CI 0.58-0.86) of a low-energy hip fracture in comparison with adherent use of hypertension drugs. The association was of the same magnitude when comparing the statin users with the population cohort, the HR being 0.69 (0.55-0.87). When women with poor (<40%), moderate (40 to 80%), and good adherence (≥ 80%) to statins were compared to those with good adherence to hypertension drugs (≥ 80%) or to the population cohort, the protective effect associated with statin use attenuated with the decreasing level of adherence.
  
  
  CONCLUSIONS
  5-year exposure to statins is associated with a reduced risk of low-energy hip fracture in women aged 50-80 years without prior hospitalizations for fractures.
authors.affiliation: Department of Pharmacology, University of Turku, Turku, Finland. arja.helin-salmivaara@utu.fi
authors.forename: Arja
authors.initials: A
authors.lastname: Helin-Salmivaara
authors.forename: Maarit J
authors.initials: MJ
authors.lastname: Korhonen
authors.forename: Petri
authors.initials: P
authors.lastname: Lehenkari
authors.forename: Seppo Y T
authors.initials: SY
authors.lastname: Junnila
authors.forename: Pertti J
authors.initials: PJ
authors.lastname: Neuvonen
authors.forename: Päivi
authors.initials: P
authors.lastname: Ruokoniemi
authors.forename: Risto
authors.initials: R
authors.lastname: Huupponen
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D015995:Prevalence; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors