Statins (3-hydroxy-3-methylglutaryl coen-zyme A reductase inhibitors) are known to enhance bone formation. Studies suggest that use of statins increases bone mineral density (BMD) in healthy patients and those with diabetes. Pasco and colleagues reviewed the association among statin use, risk of fractures, and BMD in a case control study of 1,375 women, including 573 who had a non-pathologic fracture, and a random sample of 802 same-age women who did not have a fracture.

Information about medication use, diet, and lifestyle was obtained. BMD testing was performed on all participants. Both groups were similar in age, body habitus, calcium intake, and use of alcohol, tobacco, hormone replacement therapy, steroids, and calcium and vitamin D supplements.

There were 16 statin users among the fracture group and 53 in the nonfracture group. Analysis of the results showed that statin use was associated with a 60 percent reduction in fracture risk. A pattern of higher BMD was noted among the statin users, but the differences were not statistically significant.

The authors conclude that statin use is associated with a reduced risk of fracture that may be greater than the risk expected from BMD changes alone. Further studies are needed to determine the exact effects of statin use on bone architecture.

editor's note: Fracture risk reduction among patients using statins seems to be based on documented physiologic evidence, and several population-based studies have demonstrated real risk reduction. The evidence, however, remains contradictory, according to the results of a large British population-based study that examined statin use among 81,880 patients 50 years of age or older who fractured a bone. No reduction in risk of fracture was noted among these patients, who were using statins for up to one year at frequently prescribed dosages. Further study is needed to find out whether statins really can reduce fracture risk and, if so, at what dosage and duration of use.—r.s.