Inhibitors of Hydroxymethylglutaryl-Coenzyme A Reductase and Risk of Fracture Among Older Women

Abstract

Agents that inhibit 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, known as statins, promote new bone formation in rodents and cultured human cells. Increased bone mineral density at the femoral neck has been documented with statin treatment in a small-scale study. The present case-control study compared the risk of fracture in 928 women aged 60 years and older who had an incident diagnosis of fracture of the humerus, wrist, hip, distal tibia, or vertebra and 2747 control women of similar age. Women with pathologic fractures and those treated for osteoporosis were excluded. Both groups had an average age of 76 years. Women prescribed a statin 13 times or more during the past 2 years were less likely to have a fracture. The odds ratio, adjusted for age, hospital admissions, chronic disease score, and use of nonstatin lipid-lowering drugs, was 0.48. The fracture risk was not significantly associated with a lower level of statin use. These findings imply that statins protect elderly women against nonpathologic fractures, probably by increasing bone mineral density. If this is in fact the case, the statins would be a promising means of treating osteoporosis. Lancet 2000;355:2185–2188