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Christoph R. Meier, PhD, MSc; Raymond G. Schlienger, PhD; Marius E. Kraenzlin, MD; Brigitta Schlegel, MD; Hershel Jick, MD

JAMA. 2000;283:3205-3210.

Context  Recent animal studies have suggested that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) increase bone formation, 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 lipid-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 September 1998.

Subjects  Within a base population of 91,611 individuals aged at least 50 years (28,340 individuals taking lipid-lowering drugs, 13,271 untreated individuals with a diagnosis of hyperlipidemia, and 50,000 randomly selected individuals without diagnosis of hyperlipidemia), we identified 3940 case patients who had a bone fracture and 23,379 control patients matched for age (±5 years), sex, general practice attended, calendar year, and years since enrollment in the GPRD.

Main Outcome Measures  Use of statins, fibrates, or other lipid-lowering drugs 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 associated with a significantly reduced fracture risk (adjusted odds ratio [OR], 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, respectively).

Conclusions  This study suggests that current exposure to statins is associated with a decreased risk of bone fractures in individuals age 50 years and older. This finding has a potentially important public health impact and should be confirmed further in controlled prospective trials.

Author Affiliations: Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology (Drs Meier, Schlienger, and Schlegel), and Division of Endocrinology, Diabetes, and Clinical Nutrition (Dr Kraenzlin), University Hospital, and Institute of Pharmacotherapy, Department of Pharmacy, University of Basel (Dr Schlienger), Basel, Switzerland; and Boston Collaborative Drug Surveillance Program, Boston University, School of Medicine, Lexington, Mass (Drs Meier and Jick).

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