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Extended report
Statin use is associated with reduced incidence and progression of knee osteoarthritis in the Rotterdam study
  1. S Clockaerts1,2,3,
  2. G J V M Van Osch1,4,
  3. Y M Bastiaansen-Jenniskens1,
  4. J A N Verhaar1,
  5. F Van Glabbeek2,
  6. J B Van Meurs5,
  7. H J M Kerkhof5,6,
  8. A Hofman3,6,
  9. B H Ch Stricker3,5,7,8,
  10. S M Bierma-Zeinstra1,9
  1. 1Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  2. 2Department of Orthopaedic Surgery and Traumatology, University Hospital of Antwerp, Edegem, Belgium
  3. 3Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  4. 4Department of Otorhinolaryngology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  5. 5Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  6. 6Netherlands Genomics Initiative (NGI)-Sponsored Netherlands Consortium for Healthy Aging (NCHA), The Netherlands
  7. 7Department of Medical Informatics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  8. 8Inspectorate of Healthcare, The Hague, The Netherlands
  9. 9Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Dr B H Ch Stricker, Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 1738, Rotterdam 3000 DR, The Netherlands; b.stricker{at}


Background Osteoarthritis is the most frequent chronic joint disease causing pain and disability. Besides biomechanical mechanisms, the pathogenesis of osteoarthritis may involve inflammation, vascular alterations and dysregulation of lipid metabolism. As statins are able to modulate many of these processes, this study examines whether statin use is associated with a decreased incidence and/or progression of osteoarthritis.

Methods Participants in a prospective population-based cohort study aged 55 years and older (n=2921) were included. x-Rays of the knee/hip were obtained at baseline and after on average 6.5 years, and scored using the Kellgren and Lawrence score for osteoarthritis. Any increase in score was defined as overall progression (incidence and progression). Data on covariables were collected at baseline. Information on statin use during follow-up was obtained from computerised pharmacy databases. The overall progression of osteoarthritis was compared between users and non-users of statins. Using a multivariate logistic regression model with generalised estimating equation, OR and 95% CI were calculated after adjusting for confounding variables.

Results Overall progression of knee and hip osteoarthritis occurred in 6.9% and 4.7% of cases, respectively. The adjusted OR for overall progression of knee osteoarthritis in statin users was 0.43 (95% CI 0.25 to 0.77, p=0.01). The use of statins was not associated with overall progression of hip osteoarthritis.

Conclusions Statin use is associated with more than a 50% reduction in overall progression of osteoarthritis of the knee, but not of the hip.

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  • Funding This study is financially supported by the Nuts-Ohra Foundation. SC received a scholarship from the University of Antwerp and the Anna Foundation. The Rotterdam Study is funded by the Erasmus Medical Center and Erasmus University in Rotterdam, The Netherlands Organization for Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, The Netherlands Genomics Initiative (NGI)/Netherlands Consortium for Healthy Aging (NCHA) project no 050-060–810, the European Commission framework 7 programme TREAT-OA (grant 200800), the Ministry for Health, Welfare and Sports, the European Commission (DG XII) and the Municipality of Rotterdam.

  • Competing interests None.

  • Ethics approval This study was approved by the Medical Ethics Committee of the Erasmus MC University Medical Center.

  • Patient consent Obtained.

  • Contributors All authors mentioned in this study contributed to the conception and design, or analysis and interpretation of data, drafting of the article or revising it critically for important intellectual content and final approval of the version to be published.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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