Age- and dose-dependent effect of statin use on the risk of osteoporotic fracture in older adults

Summary Previous studies have revealed the protective effects of statins on bone but the association of statins use with osteoporosis-related measurement has shown controversial results. In this study, we found an age, dose andduration–dependent osteoprotective effect of statins in general older population. Purpose Previous studies have revealed the protective effects of statins on bone but the association of statins use with osteoporotic fractures has shown controversial results. Methods In this study with Korean National Health Insurance Service-Senior cohort database, a total of 365,656 elderly without previous history of osteoporosis and who were started on statin since January 1 2004 were included and observed until December 31 2012. Hazard rations (HR) for major osteoporotic fractures were calculated using the weighted Cox proportional hazards model with inverse-probability of treatment weighting method. Results During 6.27 years of follow-up period, 54,959 osteoporotic fractures occurred and the majority of fractures (69.5%) were vertebral fractures. Compared with non-users, statin use was associated with a decreased risk of all outcomes with adjusted HR (95% CI) of 0.77 (0.72–0.83; P < 0.001) for major osteoporotic fractures, 0.49 (0.38–0.62; P < 0.001) for hip fractures, and 0.70 (0.64–0.77; P < 0.001) for vertebral fractures. When outcomes were examined separately by sex, the results were broadly comparable in terms of patterns of risk reduction by statin use. The patients with statin initiated at age ≥ 80 years had the highest risk reduction for most outcomes relative to non-users. Higher cumulative dose of statin was negatively associated with the osteoporotic fracture risk; 0.97 (0.91–1.02) for 30–364 cumulative daily defined dose (cDDD), 0.45 (0.40–0.51) for 365–1,094 cDDD, and 0.22 (0.15–0.33) for ≥ 1,095 cDDD. Conclusions Our results showed that statin use was associated with significant reduction in the risk of osteoporotic fractures in general older population.