Statin use, bone mineral density, and fracture risk - Geelong osteoporosis study

Background: Recent data suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) decrease fracture risk and increase bone mineral density (BMD). Methods: This cross-sectional study is set in southeastern Australia. We evaluated the association between statin use, fracture risk, and BMD in 1375 women (573 with incident fractures and 802 without incident fracture, all drawn from the same community). Fractures were identified radiologically. Medication use and lifestyle factors were documented by questionnaire. Results: Unadjusted odds ratio for fracture associated with statin use was 0.40 (95% confidence interval [CI],0.23-0.71). Adjusting for BMD at the femoral neck, spine, and whole body increased the odds ratio to 0.45 (95% CI, 0.25-0.80), 0.42 (95% CI, 0.24-0.75), and 0.43 (95% CI, 0.24-0.78), respectively. Adjusting for age, weight, concurrent medications, and lifestyle factors had no substantial effect on the odds ratio for fracture. Statin use was associated with a 3% greater adjusted BMD at the femoral neck (P=.08), and BMD tended to be greater at the spine and whole body but did not achieve statistical significance. Conclusion: The substantial 60% reduction in. fracture risk associated with statin use is greater than would be expected from increases in BMD alone.