Monitor high-risk statin patients for osteoporosis, say researchers

Patients taking high-dose statins who are at increased risk of osteoporosis should be monitored more frequently, according to researchers who have found a dose-dependent link with the bone condition in these individuals.

Osteoporosis is overrepresented in patients on high-dose statin treatment, according to new research. | SHEILA TERRY/SCIENCE PHOTO LIBRARY
Osteoporosis is overrepresented in patients on high-dose statin treatment, according to new research. | SHEILA TERRY/SCIENCE PHOTO LIBRARY

Research published in Annals of the Rheumatic Diseases suggests that patients on statins are almost four times as likely to develop osteoporosis than those who are not, and that the risk increases with the dose of statin.

From an Austrian medical claims database, researchers identified 353,502 patients treated with statins between January 2006 and December 2007, of whom 11,701 were diagnosed with osteoporosis. The control group (no statin exposure) consisted of 7,543,947 patients, including 68,699 patients diagnosed with osteoporosis.

The researchers found that diagnosis of osteoporosis was more prevalent in patients of any age treated with statins than in controls without statin treatment (OR 3.62, 95% CI 3.55–3.69, p<0.01). In a sex-specific analysis, the diagnosis of osteoporosis was overrepresented in both statin-treated females (OR 3.90, 95% CI 3.81–3.98, p<0.01) and males (OR 3.35, 95% CI 3.18–3.52, p<0.01).

Women aged 40–50 years taking statins were the group most likely to be diagnosed with osteoporosis.

Dose-dependent risk

The results also showed that the risk of osteoporosis increased with the dose of statin. At low doses of 0–10mg simvastatin patients were around a third less likely to be diagnosed with osteoporosis than those not on a statin, while patients on doses >40–60mg were over 1.5 times more likely and those taking >60–80mg were more than 3 times as likely.

Similar increases were seen for atorvastatin and rosuvastatin.

The results did not change significantly when the analysis was repeated excluding patients with comorbidities such as arthritis, CVD, diseases of the arteries, stroke, diabetes, renal failure, nicotine dependence, overweight and obesity, and diseases possibly treated with corticosteroids such as asthma, Crohn’s disease or COPD.

Monitoring high-risk patients, that is, postmenopausal female patients on high-dose statin therapy, 'might be useful in order to offer an individual therapy to prevent or treat osteoporosis,’ say the researchers.

The possible negative effect of statins on bone health could be mediated by reduced sex hormone production. Statins act by inhibiting the synthesis of cholesterol, the main substrate for the production of sex hormones. In the postmenopausal state, estradiol plays a crucial role in the maintenance of bone mineral density.

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