HMG-CoA reductase inhibitors and the risk of fractures

Context Recent animal studies have suggested that 3-hydroxy-3-methylglutary l coenzyme A (HMG-CoA) reductase inhibitors (statins) increase bone formati on, volume, and density. It is unknown whether use of statins is associated with a decreased risk of fractures in humans. Objective To determine whether exposure to statins, fibrates, or other lipi d-lowering drugs is associated with reduced bone fracture risk. Design Population-based, nested case-control analysis. Setting The UK-based General Practice Research Database (GPRD), comprising some 300 practices, with data collection from the late 1980s until Septembe r 1998. Subjects Within a base population of 91 611 individuals aged at least 50 ye ars (28340 individuals taking lipid-lowering drugs, 13 271 untreated indivi duals with a diagnosis of hyperlipidemia, and 50 000 randomly selected indi viduals without diagnosis of hyperlipidemia), we identified 3940 case patie nts who had a bone fracture and 23 379 control patients matched for age (+/ -5 years), sex, general practice attended, calendar year, and years since e nrollment in the GPRD, Main Outcome Measures Use of statins, fibrates, or other lipid-lowering dru gs in case patients vs control patients. Results After controlling for body mass index, smoking, number of physician visits, and corticosteroid and estrogen use, current use of statins was as sociated with a significantly reduced fracture risk (adjusted odds ratio [O R], 0.55; 95% confidence interval [CI], 0.44-0.69) compared with nonuse of lipid-lowering drugs. Current use of fibrates or other lipid-lowering drugs was not related to a significantly decreased bone fracture risk (adjusted OR, 0.87; 95% CI, 0.70-1.08 and adjusted OR, 0.76; 95% CI, 0.41-1.39, respe ctively). Conclusions This study suggests that current exposure to statins is associa ted with a decreased risk of bone fractures in individuals age 50 years and older. This finding has a potentially important public health impact and s hould be confirmed further in controlled prospective trials.