Statins Do Not Reduce Fracture Risk: JUPITER Analysis

December 01, 2014

NEW YORK, NY — Statin therapy in men and women does not protect against the risk of fracture, according to a prespecified analysis of the JUPITER study. Investigators also found that patients in JUPITER with higher baseline high-sensitivity C-reactive protein (hs-CRP) levels, indicative of systemic inflammation, did not have a higher risk of fracture than those with lower hs-CRP levels.

Reporting their findings December 1, 2014 in the JAMA: Internal Medicine, Dr Jessica Peña (Albert Einstein College of Medicine, New York) and colleagues say the results do not support the use of the lipid-lowering drugs to reduce the risk of fracture in treated patients.

There had been earlier observational studies suggesting statins reduced the risk of fracture, while other groups reported an increase in bone-mineral density with statin use. Other studies, however, including post hoc analyses of randomized, clinical trials, did not show the drugs reduced fracture risk.

In JUPITER, investigators prespecified fracture as a secondary end point with the goal of determining whether rosuvastatin (Crestor, AstraZeneca) lowered the fracture risk in men (>50 years of age) and women (>60 years of age) with elevated CRP levels at baseline. After a median follow-up of 1.9 years, there were 431 incident fractures confirmed in the trial.

In the statin- and placebo-treated arms, there were 221 and 210 fractures, respectively. The difference was not statistically significant. When researchers analyzed the data by fracture type, again, there were no significant differences between the statin and placebo arms. Neither men nor women benefited from statin therapy in terms of fracture risk.

Peña and colleagues note that high levels of hs-CRP have been linked with an increased risk of fracture in other studies, but not in the JUPITER trial. "Because JUPITER enrolled participants with elevated hs-CRP levels, our analysis of baseline hs-CRP levels and fracture risk is limited to those at the upper end of the range of hs-CRP values," they note. "The truncated range of hs-CRP level may have obscured our ability to detect a relationship between hs-CRP level and fracture risk."

Peña reported no relevant financial relationships. Disclosures for the coauthors are listed in the article.

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