title: Exposure to statins is associated to fracture risk reduction in elderly people with cardiovascular disease: evidence from the AIFA-I-GrADE observational project.
abstract: OBJECTIVE
  Conflicting findings were observed from clinical trials and observational studies evaluating the association between the use of statins and the risk of fracture. A case-control study nested into a cohort of elderly patients on treatment with statins for cardiovascular secondary prevention was performed on this issue.
  
  
  METHODS
  The cohort was formed by 13 875 individuals aged ≥65 years from several Italian health units receiving statins after hospital discharge for cardiovascular outcomes. From this cohort, 964 patients who experienced fracture were identified (i.e., cases). Up to five controls were randomly selected for each case from the underlying cohort. Conditional logistic regression was used to model the risk of fracture associated with adherence to statins, which was measured from the proportion of days covered (PDC) by treatment. A set of sensitivity analyses was performed in order to account for sources of systematic uncertainty.
  
  
  RESULTS
  Compared with patients with low adherence (PDC ≤ 40%), those on intermediate (PDC 41-80%) and high (PDC > 80%) adherence exhibited a risk reduction of 21% (95% confidence interval 6% to 23%) and 25% (7% to 40%). Similar effects were observed among patients younger and older than 80 years, as well as among men, while there was no evidence that adherence to statins affected the risk of fracture among women. Sensitivity analyses revealed that the associations were consistent and robust.
  
  
  CONCLUSIONS
  Use of statins for secondary cardiovascular prevention is associated with fracture risk reduction in elderly people. Further studies are required to better clarify the statin-fracture association in postmenopausal women. Copyright © 2017 John Wiley & Sons, Ltd.
authors.affiliation: Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
authors.forename: Federico
authors.identifier: http://orcid.org/0000-0001-7988-5101
authors.initials: F
authors.lastname: Rea
authors.affiliation: Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy.|Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonassi
authors.affiliation: Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Vitale
authors.affiliation: Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Trifirò
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cascini
authors.affiliation: Epidemiology Unit, Regional Agency for Healthcare Services of Tuscany, Florence, Italy.
authors.forename: Giuseppe
authors.identifier: http://orcid.org/0000-0001-6478-6442
authors.initials: G
authors.lastname: Roberto
authors.affiliation: Treviso Local Health Unit, Treviso, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Chinellato
authors.affiliation: Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy.
authors.forename: Ersilia
authors.initials: E
authors.lastname: Lucenteforte
authors.affiliation: Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mugelli
authors.affiliation: Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications*; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008297:Male; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: databases; fracture prevention; nested case-control; pharmacoepidemiology; rule-out sensitivity analysis; statins; unmeasured confounders