(217) Risk of Osteoporosis Associated with HMG-CoA Reductase Inhibitors in Patients with Dyslipidemia

Publication Number: 1262

Background: 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, known as "statins" are a cholesterol-lowering drugs most widely used in treatment of dyslipidemia. Several studies have shown that statin users have a lower risk of fractures or greater bone mineral density than non-users. However, a recent study has shown that the use of high dose statin increases the risk of osteoporosis.

Objectives: This study aimed to assess the risk of osteoporosis of statins compared with non-use of statins in patients with dyslipidemia in Korea.

Methods: We conducted a retrospective cohort study using the National Health Insurance Service (NHIS) database in Korea from 2011 to 2019. Patients aged ≥ 40 years and diagnosed with dyslipidemia (ICD-10, E78) between January 1, 2014 and December 31, 2015 were enrolled in this study. Statin users were defined as the patients who had at least one prescription of statins (simvastatin, lovastatin, pravastatin, fluvastatin, atorvastatin, rosuvastatin or pitavastatin). The outcome was osteoporosis. Primary analysis was performed using Cox’s proportional hazard model after 1:1 exact matching and 1:1 propensity score (PS) matching to calculate the hazard ratio (HR) with 95% confidence interval (CI). Subgroup analyses were conducted by sex, age groups (40-49, 50-59, 60-69 and ≥70 years) and statin average daily dose groups (stratified by statin intensity into low, moderate, high). Statin dose was calculated after being converted to atorvastatin equivalent dose.

Results: Statin users and non-users were paired using both exact matching and PS matching (462,900 patients per group). After adjustment, statins were associated with a lower risk of osteoporosis compared to non-use of statins (HR: 0.92, 95% CI: 0.91-0.93) and the results of subgroup analyses were consistent. Particularly, in the statin dose subgroup analysis, the risk of osteoporosis in statin users compared to non-users was 0.96 (95% CI: 0.95-0.97), 0.88 (95% CI: 0.87-0.89), and 0.75 (95% CI: 0.72-0.79) in low, moderate and high group respectively, which were statistically significantly lower in all doses.

Conclusions: Our study found that statins are significantly associated with lower risk of osteoporosis compared to those of non-use of statins. In particular, as the dose of statins increased, the risk of osteoporosis decreased, confirming a dose-response relationship.