Diagnosis of Osteoporosis in Patients Treated With Statins Is Dose Dependent

Two weeks’ supply of 20mg statin tablets in foil blister pack with one ready to be taken, on a white surface.
The diagnosis of osteoporosis was overrepresented in patients receiving high-dose and underrepresented in patients receiving low-dose statin treatment.

The diagnosis of osteoporosis was overrepresented in patients treated with high-dose and underrepresented in patients treated with low-dose statins, according to study results published in Annals of the Rheumatic Diseases.

Several previous studies have investigated the association between statin therapy and osteoporosis, but there is limited information regarding the association between different kinds and dosages of statins and a diagnosis of osteoporosis. The goal of the current study was to explore this association in a nationwide population-based study.

The cross-sectional retrospective study was based on the medical claims data of the entire Austrian population from 2006 to 2007. The researchers identified all patients treated with statins. Patients were grouped according to their average daily dose for each statin: >0 to 10 mg, >10 to 20 mg, >20 to 40 mg, >40 to 60 mg, or >60 to 80 mg.

Of 353,502 patients treated with statins, 11,701 were diagnosed with osteoporosis. A control group of patients who were not treated with statins consisted of more than 7.5 million patients; 68,699 were diagnosed with osteoporosis.

Within the whole study population, women had a 5-fold higher risk of being diagnosed with osteoporosis compared with men (odds ratio [OR], 5.08; 95% CI, 4.98-5.18; P <.01).

The diagnosis of osteoporosis was more prevalent in patients treated with statins compared with the control group (OR, 3.62; 95% CI, 3.55-3.69; P <.01); further, the association was highly dependent on dose, with osteoporosis being overrepresented in high-dose and underrepresented in low-dose statin treatment.

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In low-dose statin treatment (0-10 mg), osteoporosis was underrepresented in the simvastatin (OR, 0.70; 95% CI, 0.56-0.86; P <.01), lovastatin (OR, 0.39; 95% CI, 0.18-0.84; P <.05), pravastatin (OR, 0.68; 95% CI, 0.52-0.89; P <.01), and rosuvastatin (OR, 0.69; 95% CI, 0.55-0.87; P <.01) groups.

Diagnosis of osteoporosis was overrepresented in the group who received >40 to 60 mg of simvastatin per day (OR, 1.64; 95% CI, 1.31-2.07; P <.01) and further increased with the increase of the daily dosage (>60-80 mg simvastatin: OR, 3.30; 95% CI, 2.36-4.62; P <.01). Osteoporosis was similarly overrepresented with higher dosages of atorvastatin (>10-20 mg: OR, 1.35; 95% CI, 1.11-1.64; P <.01; >20-40 mg: OR, 1.78; 95% CI, 1.41-2.23; P <.01; >40-60 mg: OR, 2.12; 95% CI, 1.47-3.06; P <.01; >60-80 mg: OR, 3.14; 95% CI, 1.77-5.56; P <.01) and rosuvastatin treatment (>20-40 mg: OR, 2.04; 95% CI, 1.31-3.18; P <.01).

The researchers noted several study limitations, including the inclusion of patients who received statin therapy for ≥1 year only and the inability to confirm the diagnosis of osteoporosis or other risk factors for osteoporosis.

“We propose that monitoring high-risk patients, that is, postmenopausal female patients

under high-dosage statin therapy, might be useful in order to offer an individual therapy to prevent or treat osteoporosis,” the researchers concluded.

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Leutner M, Matzhold C, Bellach L, et al. Diagnosis of osteoporosis in statin-treated patients is dose-dependent [published online September 26, 2019]. Ann Rheum Dis. doi:10.1136/annrheumdis-2019-215714