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STATINS
Pharmacological theory and in vivo and animal model observations have suggested that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may increase bone mineral density, raising the hope that these drugs also may be useful in reducing risk of osteoporotic fractures. The public health implications of positive findings from statins and fracture risk trials are enormous, because these are already approved drugs utilized by many individuals for cardiovascular and cerebrovascular risk factor reduction.
According to a recent editorial in JAMA9, there are now at least 7 studies reported in full publication or abstract form that have measured the association between statin use and fracture risk. Of these, 6 used observational designs and 1 reanalyzed data from a randomized trial that was performed to evaluate cardiovascular end points. These studies appear inconsistent, with 3 positive studies and 4 that did not show a statistically significant protective effect. The question of whether statins categorically prevent fractures will be confirmed only by controlled randomized trials; fortunately large randomized trials of the effect of these drugs on cardiovascular endpoints have already been performed, and it has been suggested by some that a meta-analysis of these trials may help answer the question. In the meantime, treatment of osteoporosis should be addressed by utilizing proven therapies.
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