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Diagnosis of osteoporosis in statin-treated patients is dose-dependent
  1. Michael Leutner1,
  2. Caspar Matzhold2,3,
  3. Luise Bellach1,
  4. Carola Deischinger1,
  5. Jürgen Harreiter1,
  6. Stefan Thurner2,3,4,5,
  7. Peter Klimek2,3,
  8. Alexandra Kautzky-Willer1
  1. 1 Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
  2. 2 Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria
  3. 3 Complexity Science Hub Vienna, Vienna, Austria
  4. 4 Santa Fe Institute, Santa Fe, New Mexico, USA
  5. 5 IIASA, Laxenburg, Austria
  1. Correspondence to Professor Alexandra Kautzky-Willer, Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna 1090, Austria; alexandra.kautzky-willer{at}meduniwien.ac.at

Abstract

Objective Whether HMG-CoA-reductase inhibition, the main mechanism of statins, plays a role in the pathogenesis of osteoporosis, is not entirely known so far. Consequently, this study was set out to investigate the relationship of different kinds and dosages of statins with osteoporosis, hypothesising that the inhibition of the synthesis of cholesterol could influence sex-hormones and therefore the diagnosis of osteoporosis.

Methods Medical claims data of all Austrians from 2006 to 2007 was used to identify all patients treated with statins to compute their daily defined dose averages of six different types of statins. We applied multiple logistic regression to analyse the dose-dependent risks of being diagnosed with osteoporosis for each statin individually.

Results In the general study population, statin treatment was associated with an overrepresentation of diagnosed osteoporosis compared with controls (OR: 3.62, 95% CI 3.55 to 3.69, p<0.01). There was a highly non-trivial dependence of statin dosage with the ORs of osteoporosis. Osteoporosis was underrepresented in low-dose statin treatment (0–10 mg per day), including lovastatin (OR: 0.39, CI 0.18 to 0.84, p<0.05), pravastatin (OR: 0.68, 95% CI 0.52 to 0.89, p<0.01), simvastatin (OR: 0.70, 95% CI 0.56 to 0.86, p<0.01) and rosuvastatin (OR: 0.69, 95% CI 0.55 to 0.87, p<0.01). However, the exceeding of the 40 mg threshold for simvastatin (OR: 1.64, 95% CI 1.31 to 2.07, p<0.01), and the exceeding of a 20 mg threshold for atorvastatin (OR: 1.78, 95% CI 1.41 to 2.23, p<0.01) and for rosuvastatin (OR: 2.04, 95% CI 1.31 to 3.18, p<0.01) was related to an overrepresentation of osteoporosis.

Conclusion Our results show that the diagnosis of osteoporosis in statin-treated patients is dose-dependent. Thus, osteoporosis is underrepresented in low-dose and overrepresented in high-dose statin treatment, demonstrating the importance of future studies’ taking dose-dependency into account when investigating the relationship between statins and osteoporosis.

  • osteoporosis
  • statins
  • dose-dependency

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Handling editor Francis Berenbaum

  • Contributors Study design: ML, CM, ST, PK and AK-W. Data analysis: ML, CM, PK. Manuscript writing: ML, CM, PK. All authors read, reviewed and approved the final manuscript.

  • Funding This study was funded by the WWTF (MA16-045).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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