Research Highlights
Large study of veterans links statins with bone health
September 23, 2005
Researchers who compared the medical charts of more than 91,000 Department of Veterans Affairs (VA) patients found that those on statins were 36% less likely to break a bone than those not on the cholesterol-lowering drugs. The study, one of the largest to-date to evaluate whether statins help prevent fractures, appears in the Sept. 26, 2005 Archives of Internal Medicine.
While the researchers say their study doesn't show cause and effect, the findings will likely fuel the debate over whether the much-touted drugs-taken by more than 12 million Americans-really do strengthen bones.
"This finding is particularly important because millions of people suffer from fractures that potentially could be prevented, to some extent, by a therapy that's so commonly used," said lead author Richard E. Scranton, MD, of VA's Boston-based Massachusetts Veterans Epidemiology Research Information Center (MAVERIC); Brigham and Women's Hospital; and Harvard Medical School.
Statins, which include popular brands such as Lipitor and Zocor, are designed to lower cholesterol by blocking an enzyme that enables natural production of cholesterol in the liver. When the liver is low in cholesterol, it takes in more of the waxy, artery-clogging substance from the bloodstream, thus lowering heart risk. But several studies in recent years have suggested further health benefits for the drugs, possibly due to their antioxidant and anti-inflammatory properties. The exact mechanism by which statins may help bones is unclear, but several theories exist.
In the new study, researchers analyzed the records of 91,052 patients-mostly men-who received care at the New England Veterans Healthcare System between January 1998 and June 2001. More than 28,000 of the patients had prescriptions for statins, while more than 2,000 others were on non-statin cholesterol-lowering drugs. After the researchers adjusted for differences in patients' age, sex, race, weight and general health, they found that the statin group had a 36% lower risk of bone fractures when compared with those on no lipid-lowering therapy. The statin group had a slightly smaller, but still significant, edge-32%-over those on cholesterol-lowering drugs other than statins.
According to Scranton, the comparison between the two groups on cholesterol-lowering drugs-statins versus non-statins-is key. Some proponents of statins assert that randomized trials have failed to show a bone benefit for the drugs because the studies compared two groups of patients with similarly high cholesterol levels. And higher cholesterol by itself-or as a marker for higher body weight-may be bone-protective, regardless of statin use. By showing that statin-users have fewer fractures even compared to non-statin users with similar cholesterol and weight profiles, Scranton's team validates the view that statins themselves may be the crucial factor.
"We believe that additional studies should be performed to fully describe the potential role of statins in protecting bones," said Scranton. "The need is too great to ignore this finding, particularly when we consider that one class of drugs could potentially reduce the suffering of two common conditions plaguing our society-heart attacks and bone fractures."
Even if further study does confirm that statins directly benefit bones, physicians are unlikely to prescribe the drugs mainly for that purpose. The drugs may cause side effects, ranging from mild stomach upset to serious liver damage or muscle pain, so strategies such as mineral supplementation or weight-bearing exercise would likely be a better approach for most people.
* The study was funded by VA's Cooperative Studies Program, the National Institutes of Health, and the Arthritis Foundation. Collaborating with Scranton were Melissa Young, MPH, and Elizabeth Lawler, MPH, of MAVERIC; Daniel Solomon, MD, MPH, of Brigham and Women's Hospital and Harvard; David Gagnon, MD, PhD, of MAVERIC and the Boston University School of Public Health; and senior author Michael Gaziano, MD, of MAVERIC, Brigham and Women's, and Harvard.