Statins Decrease Osteoporotic Fracture Risk Among Adults Aged 60 Years and Older

Statin use was associated with a reduced risk for osteoporotic fracture among adults aged 60 years and older, according to study results published in Osteoporosis International.

Past research has demonstrated the association of statins with increased bone mineral density (BMD) and lower fracture risks. Investigators assessed the relationship between different types and dosages of statins and the risk for osteoporotic fracture among older adults.

A retrospective population-based study was conducted using data from the Korean National Health Insurance Service-Senior cohort. Patients aged at least 60 years without a previous history of osteoporosis who were started on statin therapy and had no previous statin prescriptions within the past 12 months (statin users) were included in the analysis. The study period began on January 1, 2004, and participants were observed until December 31, 2012.

A total of 21,318 statin-users and 344,338 nonusers were included in the study. Mean participant ages were 70.5 years among the statin-user group and 70.3 years among the nonuser group.

Among the statin-user group, 7.9% (1675 participants) of participants developed major osteoporotic fractures with an overall incidence of 21.6 per 1000 person-years (PY). A total of 15.5% (53,284 participants) of participants in the nonuser group developed major osteoporotic fractures with an overall incidence of 24.1 per 1000 PY.

Vertebral (69.4%), distal radius (28.9%), hip (16.1%), and humerus (1.40%) fractures were the most common osteoporotic fractures among both groups.

Compared with the nonuser group, statin use was associated with a lower risk of developing major osteoporotic fractures (hazard ratio [HR], 0.77; 95% CI, 0.72-0.83),  vertebral fractures (HR, 0.70; 95% CI, 0.64-0.77), and hip fractures (HR, 0.49; 95% CI, 0.38-0.62).

Osteoporotic fracture risk decreased with increasing age at initiation of statin therapy (HRs among patients aged 60-69 years vs ≥80 years, 0.79 vs 0.65, respectively). Statin users had a lower risk for nonvertebral fractures regardless of age, while incremental risk reduction in vertebral fractures generally declined with increasing age at statin initiation.

The risk for major osteoporotic fracture was reduced by 14% among participants exposed to statins for less than 2 years (HR, 0.86; 95% CI, 0.81-0.91) and by 21% among those exposed for 2 years or more (HR, 0.79; 95% CI, 0.72-0.87). Additionally, the risk for major osteoporotic fracture decreased with increasing statin dosage.

Study limitations included the retrospective, observational design, lack of data on BMD, potential confounding factors, and detection bias. Additionally, treatment interruption and adherence were not evaluated.

The study authors concluded, “Based on these findings, we can speculate that the beneficial effect of statin may be more pronounced in aged and fragile bones. Given the increasing prevalence of vertebral fractures with subsequent mortality, statin treatment should be recommended even in very old people.”