Acta Chir Orthop Traumatol Cech. 2022; 89(2):104-107 | DOI: 10.55095/achot2022/015
Use of Statins and Hip Fracture Risk: a Case-Control StudyOriginal papers
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
PURPOSE OF THE STUDY:
To evaluate a possible association between hip fracture and statin use.
MATERIAL AND METHODS:
In this case-control study we compared the use of statins between two groups of 210 patients: the first group (case group) included patients hospitalized for hip fractures while the second group (control group) included patients who did not suffer femur bone injuries. The two groups were matched for age, sex, year of hospitalization and possible confounding factors. Inside the group of cases, we also evaluated the differences in terms of fracture type, presence of previous fragility fracture and mortality between statin users and non-users.
RESULTS:
The use of statins was most common among patients without previous fractures (OR=0.54; 95% CI=0.33-0.89; p=0.0138), especially in older patients (OR=0.40; 95% CI=0.22-0.76). We did not find any significant difference in statin intake between men and women in the control group. In the case group, those who did not use statins were more likely to undergo a medial hip fracture (28.5% vs 16.1%). Patients from case group also presented a greater mortality (27.9% vs 19.35%) and an higher percentage of previous hip fractures (20.11% vs 9.7%). However, they didn't presented a significant higher rate of fragility fractures in other sites.
DISCUSSION: AND CONCLUSIONS
Our study suggests a reduced hip fracture risk, especially in cases aged 80 or more, a different fracture pattern (lower percentage of medial fractures) and a reduced mortality at 9 months in patients treated with HMG-CoA reductase inhibitors, confirming the previous evidences reported in literature.
Keywords: statin, hip fractures, fracture risk, osteoporosis
Published: April 15, 2022 Show citation
ACS | AIP | APA | ASA | Harvard | Chicago | Chicago Notes | IEEE | ISO690 | MLA | NLM | Turabian | Vancouver |
References
- Adams AL, Shi JM, Reynolds K, Haque R, Cheetham TC, Kawatkar AA, Fithian DC, Jacobsen SJ. Statins and hip fracture risk in men: a population-based case-control study. Ann Epidemiol. 2015;5:844-848.
Go to original source...
Go to PubMed...
- An T, Hao J, Sun S, Li R, Yang M, Cheng G, Zou M.. Efficacy of statins for osteoporosis: a systematic review and meta-analysis. Osteoporos Int. 2017;28:47-57.
Go to original source...
Go to PubMed...
- Bauer DC. HMG CoA reductase inhibitors and the skeleton: a comprehensive review. Osteoporos Int. 2003;14:273-282.
Go to original source...
Go to PubMed...
- Cassell E, Clapperton A. A decreasing trend in fall-related hip fracture incidence in Victoria, Australia. Osteoporos Int. 2013;24:99-109.
Go to original source...
Go to PubMed...
- Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med. 1997;103:7S-12S.
Go to original source...
Go to PubMed...
- Dionigi R, Cabitza P, Pace A, Randelli P, Pace F. Chirurgia. 6th ed., Edra, Milan, 2017.
- Gennaro AR, Franz DN. Remington: The science and practice of pharmacy. 20th ed., Lippincott Williams and Wilkins, Philadeplhia, 2000.
- Greenspan FS, Strewler GJ, Strewler Gordon J. Endocrinologia generale e clinica. 5th ed., Piccin, Padua, 1997.
- Guido G, Scaglione M, Fabbri L, Ceglia MJ. The "osteoporosis disease". Clin Cases Miner Bone Metab. 2009;6:114-116.
- Jin S, Jiang J, Bai P, Zhang M, Tong X, Wang H, Lu Y. Statin use and risk of fracture: a meta-analysis. Int J Clin Exp Med. 2015;8:8269-275.
- Juliebo V, Krogseth M, Skovlund E, Engedal K, Wyller TB. Medical treatment predicts mortality after hip fracture. J Gerontol A Biol Sci Med Sci J. 2010;65:442-449.
Go to original source...
Go to PubMed...
- Kasper D, Lindsay R, Cosman F, Fauci AS. Harrison's principles of internal medicine. 19th ed., Editrice Ambrosiana, Milan, 2017, pp.3232-3250.
- Lewiecki EM. Prevention and treatment of postmenopausal osteoporosis. Obstet Gynecol Clin North Am. 2008;35:301-315, ix.
Go to original source...
Go to PubMed...
- Lupattelli G, Scarponi AM, Vaudo G, Siepi D, Roscini AR, Gemelli F, Pirro M, Latini RA, Sinzinger H, Marchesi S, Mannarino E. Simvastatin increases bone mineral density in hypercholesterolemic postmenopausal women. Metab Clin Exp. 2004;53:744-748.
Go to original source...
Go to PubMed...
- Meinberg E, Agel J, Roberts C. Fracture and dislocation classification compendium - 2018. J Orthop Trauma. 2018;32:S1-S170.
Go to original source...
Go to PubMed...
- Metcalfe D. The pathophysiology of osteoporotic hip fracture. McGill J Med. 2008;11:51-57.
Go to original source...
- Moore EE, Feliciano DV, Mattox KL, Dawson L, El Naga A, Atassi O. Trauma. 8.a. McGraw-Hill, 2017, pp.815-818.
- Mundy G, Garrett R, Harris S, Chan J, Chen D, Rossini G, Boyce B, Zhao M, Gutierrez G. Stimulation of bone formation in vitro and in rodents by statins. Science.1999;286:1946-1949.
Go to original source...
Go to PubMed...
- Pasco JA, Kotowicz MA, Henry MJ, Sanders KM, Nicholson GC, Geelong Osteoporosis Study. Statin use, bone mineral density, and fracture risk: Geelong Osteoporosis Study. Archiv Intern Med. 2002;162:537-340.
Go to original source...
Go to PubMed...
- Piscitelli P, Feola M, Rao C, Celi M, Gasbarra E, Neglia C, Quarta G, Liuni FM, Parri S, Iolascon G, Brandi ML, Distante A, Tarantino U. Ten years of hip fractures in Italy: for the first time a decreasing trend in elderly women. World J Orthop. 2014;5:386-391.
Go to original source...
Go to PubMed...
- Piscitelli P, Iolascon G, Argentiero A, Chitano G, Neglia C, Marcucci G, Pulimeno M, Benvenuto M, Mundi S, Marzo V, Donati D, Baggiani A, Migliore A, Granata M, Gimigliano F, Di Blasio R, Gimigliano A, Renzulli L, Brandi ML, Distante A, Gimigliano R. Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records. Clin Interv Aging. 2012;7:575-583.
Go to original source...
Go to PubMed...
- Rejnmark L, Buus NH, Vestergaard P, Heickendorff L, Andreasen F, Larsen ML, Mosekilde L. Effects of simvastatin on bone turnover and BMD: a 1-year randomized controlled trial in postmenopausal osteopenic women. J Bone Miner Res. 2004;19:737-744.
Go to original source...
Go to PubMed...
- Rejnmark L, Olsen ML, Johnsen SP, Vestergaard P, Sorensen HT, Mosekilde L. Hip fracture risk in statin users - a population-based Danish case-control study. Osteoporos Int. 2004;15:452-458.
Go to original source...
Go to PubMed...
- Rejnmark L, Vestergaard P, Mosekilde L. Statin but not non-statin lipid-lowering drugs decrease fracture risk: a nation-wide case-control study. Calcif Tissue Int. 2006;79:27-36.
Go to original source...
Go to PubMed...
- Rizzo M, Rini GB. Statins, fracture risk, and bone remodeling: What is true? Am J. Med. Sci. 2006;332:55-60.
Go to original source...
Go to PubMed...
- Safaei H, Janghorbani M, Aminorroaya A, Amini M. Lovastatin effects on bone mineral density in postmenopausal women with type 2 diabetes mellitus. Acta Diabetol. 2007;44:76-82.
Go to original source...
Go to PubMed...
- Scaglione M, Fabbri L, Casella F, Guido G. Strontium ranelate as an adjuvant for fracture healing: clinical, radiological, and ultrasound findings in a randomized controlled study on wrist fractures. Osteoporos Int. 2016;27:211-218.
Go to original source...
Go to PubMed...
- Solomon DH, Finkelstein JS, Wang PS, Avorn J. Statin lipid-lowering drugs and bone mineral density. Pharmacoepidemiol Drug Saf. 2005;14:219-226.
Go to original source...
Go to PubMed...
- Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR, Osteoporotic Fractures Research Group. BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res. 2003;18:1947-1954.
Go to original source...
Go to PubMed...
- Tarantino U, Piscitelli P, Feola M, Neglia C, Rao C, Gimigliano F, Iolascon G. Decreasing trend of hip fractures incidence in Italy between 2007 and 2014: epidemiological changes due to population aging. Arch Osteoporos. 2018;13:23.
Go to original source...
Go to PubMed...
- Toh S, Hernandez-Diaz S. Statins and fracture risk. A systematic review. Pharmacoepidemiol Drug Saf. 2007;16:627-640.
Go to original source...
Go to PubMed...
- Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY. Effects of statins on bone mineral density: a meta-analysis of clinical studies. Bone. 2007;40:1581-1587.
Go to original source...
Go to PubMed...
- van Staa TP, Wegman S, de Vries F, Leufkens B, Cooper C. Use of statins and risk of fractures. JAMA. 2001;285:1850-1855.
Go to original source...
Go to PubMed...
- Ward IM, Mortensen EM, Battafarano DF, Frei CR, Mansi I. Association of statins and risk of fractures in a military health system: a propensity score-matched analysis. Ann Pharmacother. 2014;48:1406-1414.
Go to original source...
Go to PubMed...
- Warriner AH, Patkar NM, Curtis JR, Delzell E, Gary L, Kilgore M, Saag K. Which fractures are most attributable to osteoporosis? J Clin Epidemiol. 2011;64:46-53.
Go to original source...
Go to PubMed...