Higher Cumulative Use Research Articles

HMG-CoA reductase inhibitors and the risk of vertebral fracture.

Statins inhibit an enzyme in the mevalonate pathway and therefore may affect bone. In this first study on both symptomatic and nonsymptomatic vertebral fractures in the elderly (N = 3469), we show that long-term statin use is significantly associated with a 50% lower vertebral fracture risk. Randomized trials on statins and fractures, carried out in populations at risk for fractures, are needed. Statins are cholesterol-lowering agents that could potentially affect bone. Previous studies on statin use and fracture risk reported contradictory results and did not include both symptomatic and nonsymptomatic vertebral fractures. To examine the association between statin use, vertebral fractures, and lumbar spine BMD, we performed a prospective population-based cohort study in men and women (N = 3469) > or =55 years of age. These individuals had both baseline and follow-up spinal X-rays available. Statin use was obtained from detailed computerized pharmacy data, and the total number of days of exposure before second X-ray was calculated. A multivariate logistic regression model was fitted to calculate odds ratios and CIs. During a mean follow-up of 6.5 years, 176 incident vertebral fractures occurred. There were 508 statin users and 16 exposed cases. The adjusted relative risk for incident vertebral fracture in users of statins (compared with nonusers) was 0.58 (95% CI, 0.34-0.99). The relative risk decreased on higher cumulative use to 0.52 (95% CI, 0.28-0.97) for use for more than 365 days during the study period. Use of (the hydrophilic statin) pravastatin and use of nonstatin cholesterol-lowering drugs was not significantly associated with vertebral fracture risk. Statin use was not significantly associated with lumbar spine BMD. Statin use is associated with a lower risk of vertebral fracture. Randomized clinical trials in a population at risk for fracture are needed to examine this association.

Quality of Mother-Infant Attachment and Pediatric Health Care Use

The relationship between infant pediatric care use in the first year of life and the quality of mother-infant attachment at 1-year of age was examined. Fifty-six mother and infant pairs were classified by the Ainsworth Strange Situation procedure as securely (n = 17) or anxiously attached (n = 39). Pediatric records for the first 12 months of life were reviewed for frequency and type of visit, diagnoses, treatment, and symptoms prompting the care visit. Anxiously attached infants used acute care services (walk-in and emergency room) significantly earlier and more often than infants with a secure attachment. Use of acute care services began at a mean age of 3.8 months for the anxiously attached infants compared with 6.5 months for the securely attached. Differences in utilization persisted through the year. Mean acute care use in the anxiously attached infants was 3.6 visits compared with 1.9 visits for the securely attached. Acute care use was associated with a variety of common infant illnesses in both groups. In contrast, there was no difference in the use of well-baby care (mean 6 visits). Utilization and attachment status were independent of birth or prenatal difficulties. High cumulative use of pediatric care during the first year of life may identify infant and mother pairs who are experiencing strain in their interactions and relationship. Early recognition would provide an opportunity for comprehensive assessment and preventive intervention in the pediatric setting.