A systematic review and meta-analysis of the effect of statins on osteoporotic fractures

Abstract

Introduction: Statins can increase bone density and improve osteoporosis. As fractures are the worst outcome of osteoporosis, our study aimed to investigate the relationship between statins and osteoporotic fractures using a systematic review and meta-analysis. Materials and Methods: A systematic review and meta-analysis were conducted using the PRISMA checklist to draft this article. ProQuest, PubMed, Web of Science, Cochrane, and Google Scholar were searched to access sources without time restrictions until November 10, 2023. Data analysis was performed using STATA 14 software. Results: About 12 studies showed that statins generally reduced osteoporotic fractures (OR: 0.82; 95% CI: 0.72, 0.94). The association between statins and osteoporotic fractures in case-control studies (OR: 0.92; 95% CI: 0.76, 1.11), RCT studies (OR: 1.67; 95% CI: 0.86, 3.26), and cohort studies (OR: 0.70; 95% CI: 0.59, 0.83) was observed. The likelihood of osteoporotic fractures with the use of pravastatin (OR: 0.96; 95% CI: 0.87, 1.07), fluvastatin (OR: 0.88; 95% CI: 0.75, 1.03), atorvastatin (OR: 0.92; 95% CI: 0.76, 1.10), rosuvastatin (OR: 0.85; 95% CI: 0.66, 1.08), and simvastatin (OR: 0.98; 95% CI: 0.92, 1.03) was noted. Additionally, statins led to a reduction in vertebral fractures (OR: 0.74; 95% CI: 0.65, 0.86) but showed no effect on the hip region (OR: 0.78; 95% CI: 0.60, 1.01). In the groups of 30–364 cumulative defined daily doses (cDDD) (OR: 0.84; 95% CI: 0.65, 1.08) and ≥365 cDDD (OR: 0.50; 95% CI: 0.25, 1), no significant association was observed between statins and osteoporotic fractures. Conclusion: Overall, statins resulted in an 18% reduction in the risk of osteoporotic fractures. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (CRD42023484864) and Research Registry (UIN: reviewregistry1750) website.