Clinical Epidemiology (Jan 2018)
High-potency statins but not all statins decrease the risk of new-onset osteoporotic fractures: a nationwide population-based longitudinal cohort study
Abstract
Tsung-Kun Lin,1,2 Yi-Sheng Liou,3,4 Ching-Heng Lin,5 Pesus Chou,2 Gwo-Ping Jong6 1Department of Pharmacy, Taoyuan Armed Forces General Hospital, Taoyuan, 2Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, 3Department of Family Medicine and Geriatrics, Taichung Veteran General Hospital, Taichung, 4School of Public Health, National Defense Medical Center, Taipei, 5Department of Medical Research, Taichung Veterans General Hospital, Taichung, 6Division of Internal Cardiology, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan, Republic of China Background: Statins have been linked to new-onset osteoporotic fractures (NOFs), and different statins may alter the risk for the development of NOFs.Aim: In this study, we investigated the association between different statins and the development of NOFs.Patients and methods: This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance, including case patients with NOFs from January 2004 to December 2013 and non-NOF subjects. We estimated the hazard ratios (HRs) of NOFs associated with statin use. Nonuser subjects served as the reference group.Results: A total of 44,405 patients with NOFs were identified from among 170,533 patients with hyperlipidemia during the study period. The risk of developing NOFs after adjusting for age, sex, comorbidities, and concurrent medication use was lower among users of atorvastatin (HR, 0.77; 95% CI, 0.71–0.84) and rosuvastatin (HR, 0.72; 95% CI, 0.64–0.81) than among simvastatin users. Lovastatin, pravastatin, fluvastatin, and pitavastatin were not associated with the risk of developing NOFs compared with simvastatin users.Conclusion: This study supports previous reports regarding a beneficial effect of statin use and NOF risk, but not all statins. Patients taking atorvastatin or rosuvastatin were at lower risk of developing NOFs compared with simvastatin users during the 10-year follow-up. Other statins such as pravastatin, fluvastatin, lovastatin, and pitavastatin were not associated with NOFs. This study also highlighted that high-potency statin has a dose–response effect on lower NOF risk. Keywords: statins, new-onset osteoporosis fracture, hyperlipidemia
