Statin Use Is Associated With Decreased Osteoporosis and Fracture Risks in Stroke Patients

Shu-Man Lin; Jen-Hung Wang; Chung-Chao Liang; Huei-Kai Huang

Disclosures

J Clin Endocrinol Metab. 2018;103(9):3439-3448. 

In This Article

Abstract and Introduction

Abstract

Context: Poststroke osteoporosis and consequent fractures increase the risk of morbidity and mortality and cause considerable socioeconomic burden.

Objective: To evaluate the association between statin use and risks of osteoporosis and fracture in stroke patients.

Design: Population-based propensity score–matched cohort study.

Setting: Taiwan's National Health Insurance Research Database.

Patients: Patients newly diagnosed with a stroke between 2000 and 2012 were identified. After propensity score matching, 5254 patients were included, with 2627 patients in the statin and nonstatin cohorts, respectively.

Main Outcome Measures: Hazard ratios (HRs) for poststroke osteoporosis, hip fracture, and vertebral fracture (together, the primary outcome) were calculated using Cox proportional hazards regression models according to statin use status.

Results: Poststroke statin use was associated with a lower overall risk of the primary outcome [adjusted hazard ratio (aHR) = 0.66; P < 0.001]. In subanalyses, statin use was associated with a decreased risk of all individual outcomes, including osteoporosis (aHR = 0.68; P < 0.001), hip fracture (aHR = 0.59; P < 0.001), and vertebral fracture (aHR = 0.73; P = 0.003). A dose-effect relationship was identified. The aHRs for developing the primary outcome were 0.96, 0.86, and 0.34 for patients who used 1 to 90, 91 to 365, and > 365 cumulative defined daily doses of statins, respectively. These dose-effect relationships were maintained on subgroup analyses stratified by age, sex, and stroke type and sensitivity analyses conducted without propensity score matching.

Conclusions: Statin use is associated with decreased risks of osteoporosis, hip fracture, and vertebral fracture in stroke patients.

Introduction

Osteoporosis is a systemic skeletal disease characterized by impairment of bone density, strength, and microarchitecture. Osteoporosis can increase the risk of fragility fractures and therefore is associated with considerable medical and socioeconomic burdens. Hip and vertebral fractures are the most common sites of osteoporotic fracture, with both having the potential to significantly increase the risks for disability, morbidity, and mortality.[1–3]

Stroke is a major risk factor for osteoporosis and fractures owing to substantial loss of bone mineral density (BMD), gait disability, balance impairment, immobilization, and increase in fall risk after the stroke.[4–7] Fractures, which are a common complication of stroke, can further reduce functional recovery, prolong disability, and increase the mortality risk among stroke patients.[8,9] Thus, it is imperative to develop strategies for osteoporosis and fracture prevention among stroke survivors.

Statins, also known as 3-hydroxy 3-methylglutaryl coenzyme A reductase inhibitors, were developed to treat hyperlipidemia, with a proven therapeutic benefit for the prevention and treatment of cardiovascular disease.[10–12] Some studies have indicated a further therapeutic role of statins in decreasing the risk of osteoporosis and bone fracture,[13,14] but conflicting results have been reported.[15,16] Because statins control dyslipidemia and prevent cardiovascular disease recurrence,[17] a considerable proportion of stroke survivors receive statins in clinical practice. However, previous studies evaluating the association between the use of statins and the risks of osteoporosis and bone fractures have typically been performed in a general population. Moreover, no recent study assessing this relationship has focused specifically on stroke patients.

To date, it is unclear whether the use of statins can decrease the risk of osteoporosis and bone fracture after a stroke. Therefore, we aimed to evaluate the association of statin use and the risk of osteoporosis, hip fracture, and vertebral fracture in patients after a stroke.

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