title: Association of statins and risk of fractures in a military health system: a propensity score-matched analysis.
abstract: BACKGROUND
  Contradictory evidence exists regarding statin use and risk of osteoporotic fractures.
  
  
  OBJECTIVE
  The study objective was to examine the effect of statins on fracture risk in a Military Healthcare System (MHS) with similar access and standard of health care for its beneficiaries.
  
  
  METHODS
  This is a retrospective study of patients enrolled in an MHS encompassing the period from October 1, 2003, to March 1, 2010. Statin users were defined as those receiving a statin for ≥90 days in Fiscal Year 2005, whereas nonusers were defined as individuals not receiving a statin throughout the study period. A propensity score-matched cohort of statin users and nonusers was created using 42 variables. The outcomes were identified using ICD-9-CM codes in the follow-up period (October 1, 2006, to March 1, 2010). In all, 4 outcomes were examined: all fractures, femoral neck fractures, upper-extremity fractures, and lower-extremity fractures.
  
  
  RESULTS
  Of 46 249 patients, 6967 pairs of statin users and nonusers were matched. Statin users had a lower risk of femoral neck fracture in comparison to nonusers (odds ratio=0.58, 95% CI=0.36-0.94) but similar risk of all fractures, lower-extremity fractures, and upper-extremity fractures.
  
  
  CONCLUSIONS
  In this cohort of patients managed in an MHS, statin use was associated with a lower risk of femoral neck fractures, but not all fractures, upper-extremity fractures, or lower-extremity fractures.
authors: San Antonio Military Medical Center and the San Antonio Uniformed Services Health Consortium, Ft Sam Houston, TX, USA.
authors: Ian M
authors: IM
authors: Ward
authors: VA North Texas Health Care System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Eric M
authors: EM
authors: Mortensen
authors: San Antonio Uniformed Services Health Education Consortium Brooke Army Medical Center, San Antonio, TX, USA.
authors: Daniel F
authors: DF
authors: Battafarano
authors: The University of Texas at Austin, Austin, TX, USA The University of Texas Health Science Center, San Antonio, TX, USA.
authors: Christopher R
authors: CR
authors: Frei
authors: VA North Texas Health Care System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA Ishak.mansi@va.gov.
authors: Ishak
authors: I
authors: Mansi
mesh_terms: D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D016017:Odds Ratio; D057216:Propensity Score; D012189:Retrospective Studies; D012306:Risk
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: fractures; hip fracture; observational studies; statin