By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

The statin drugs such as Zocor, Pravachol, and Lipitor (also known as HMG –Co A reductase inhibitors) have been found to be very effective at lowering blood cholesterol levels and also at preventing heart attacks and strokes. Some recent studies in animals have suggested that they may also lead to increased bone formation, a property that was unexpected when they were first introduced. Now two observational surveys in humans have examined their effectiveness at preventing bone fractures, which occur commonly in older people as a result of osteoporosis, which is basically a thinning of the bones.

The first study was an analysis of a large database collected in 90,000 people who were attending 300 family practices in the UK, and who were surveyed between 1980 and 1998. The survey identified 3,940 people who had a bone fracture and compared them with 23,000 who did not have one. It was found that people who were taking statin drugs had about half the risk of having a fracture than those who were not taking statins. But taking other drugs used to lower cholesterol did not affect the chances of having a fracture.

The second was a survey of 6,000 elderly patients in New Jersey who were on Medicare or Medicaid, and for whom pharmacy records were available. The findings were very similar: people taking statins had half the risk of having surgery for a fractured hip than those not taking statins, and the risk was progressively lower the longer the patients had been on statins. Again, other lipid lowering drugs appeared to have no effect.

Doctor’s comments

These are startling findings, and the fact that the results were almost identical in the two studies gives them great credibility. The limitation of both studies was that they were observational - not randomized controlled trials, which will be ultimately needed to prove conclusively that the statin drugs do have this protective effect. What neither study can completely rule out is that there was some other reason why patients taking statins should have less fractures, although the fact that other drugs used to lower lipids did not appear to prevent fractures makes this unlikely. Also, the results of the animal studies, which originally prompted these surveys, lend support to the findings. We will need randomized controlled trials before we can recommend statins specifically to prevent osteoporosis, but in the meantime, these studies strengthen the case for wider use of the statins in older people.

Where it was published

CR Meier and colleagues. HMG-CoA reductase inhibitors and the risk of fractures. Journal of the American Medical Association 2000; 283: 3205.