Abstract
BackgroundSeveral observational cohort and meta-analytical studies in humans have shown that statin users have a lower risk of fractures or greater bone mineral densities (BMD) than nonusers. However, some studies including randomized clinical trials have the opposite results, particularly in Asian populations.ObjectiveThis study investigates the impacts of statins on new-onset osteoporosis in Taiwan.MethodsIn a nationwide retrospective population-based cohort study, 45,342 subjects aged between 50–90 years having received statin therapy (statin-users) since January 1 2001, and observed through December 31 2013 were selected from the National Health Insurance Research Database of Taiwan. Likewise, 115,594 patients had no statin therapy (statin-non-users) were included as controls in this study. Multivariable Cox proportional hazards analysis for drug exposures was employed to evaluate the association between statin treatment and new-onset of osteoporosis risk. We also used the long-rank test to evaluate the difference of probability of osteoporosis-free survival.ResultsDuring the 13-year follow-up period, 16,146 of all enrolled subjects (10.03%) developed osteoporosis, including 3097 statin-users (6.83%) and 13,049 statin-non-users (11.29%). Overall, statin therapy reduced the risk of new-onset osteoporosis by 48% (adjusted hazard ratio [HR] 0.52; 95% CI 0.50 to 0.54). A dose-response relationship between statin treatment and the risk of new-onset osteoporosis was observed. The adjusted hazard ratios for new-onset osteoporosis were 0.84 (95% CI, 0.78 to 0.90), 0.56 (95% CI, 0.52 to 0.60) and 0.23 (95% CI, 0.21 to 0.25) when cumulative defined daily doses (cDDDs) ranged from 28 to 90, 91 to 365, and more than 365, respectively, relative to nonusers. Otherwise, high-potency statins (rosuvastatin and atorvastatin) and moderate-potency statin (simvastatin) seemed to have a potential protective effect for osteoporosis.ConclusionsIn this population-based cohort study, we found that statin use is associated with a decreased risk of osteoporosis in both genders. The osteoprotective effect of statins seemed to be more prominent with a dependency on the cumulative dosage and statin intensity.
Highlights
Statins, known as hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors, have been widely used as cholesterol-lowering drugs and there is strong evidence for beneficial effects for patients at risks for cardiovascular diseases [1,2,3]
Statin therapy reduced the risk of new-onset osteoporosis by 48%
Highpotency statins and moderate-potency statin seemed to have a potential protective effect for osteoporosis. In this population-based cohort study, we found that statin use is associated with a decreased risk of osteoporosis in both genders
Summary
Known as hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors, have been widely used as cholesterol-lowering drugs and there is strong evidence for beneficial effects for patients at risks for cardiovascular diseases [1,2,3]. Their efficacy and safety have been well documented in many primary and secondary clinical trials. Cumulative experience and evidence revealed new adverse effects from statins such as new-onset diabetes, cognitive impairment, and dementia [4,5,6] In addition to their well-known cholesterol-lowering properties and potential adverse effects, other advantageous pleiotropic effects of statins have been noticed. Some studies including randomized clinical trials have the opposite results, in Asian populations
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