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More Evidence Cholesterol Drugs Reduce Fracture Risk


On their own in study after study, statins have a stellar track record. Clinical evidence suggests that statins can prolong life in the face of heart attack, reduce the risk of stroke, and lower blood pressure. Nonetheless, Philip S. Wang, MD, DrPH, lead author of one of the JAMA studies, says it is far too soon to "consider [statins] as the one-pill solution."

Yet, the prospect is attractive, and even as he urges restraint, Cummings says that UCSF is in the planning stages of a study on using statins for osteoporosis. He says the trial is being planned with the assistance of Gregory Mundy, MD, PhD, the author of the rat study published in Science late last year.

Mundy, professor of medicine at the University of Texas Health Science Center San Antonio, tells WebMD that he is "tremendously pleased with all these studies. Firstly, because they suggest that statins are effective in humans and secondly, they show that they may be effective at [the normal cholesterol-lowering doses]."

Since publishing his animal work, Mundy says he had been pursuing the concept of a "bone statin", which would be delivered by a skin patch. The skin patch could potentially keep more of the drug working in the body because it would avoid breakdown by the stomach and intestines. But these recent studies suggest the skin patch may not be needed to protect against fractures because the oral form seems to work for fracture prevention.

Mundy says he is especially encouraged by the JAMA paper from Christoph R. Meier, MD, PhD, of the University Hospital of Basel Switzerland, because that study suggests that statins may begin to make a difference quickly -- in a few weeks to a few months.

Meier's group studied nearly 4,000 fracture patients aged 50 to 89 and compared their statin use to patients of the same age range and gender with no fractures. They found that current statin use reduced fracture risk by 45%, while recent statin use reduced the risk by 33%, and any history of statin use reduced risk by 13%.

In the second JAMA paper, Philip S. Wang MD, DrPH, of Brigham and Women's Hospital in Boston, studied data collected from New Jersey residents aged 65 or older who were enrolled in Medicare, Medicaid, or the Pharmacy Assistance for the Aged and Disabled program. They identified 1,222 patients who had hip fractures in 1994 and compared their statin use to 4,888 healthy people.

"We found that statin use for 180 days prior was associated with a 50% reduction in hip fracture risk, and use of statins in the prior three years was associated with a 43% decrease in risk," Wang tells WebMD.

Cummings says that although the data from this cluster of studies is very encouraging, there are factors that need to be considered For example, when drugs seem to work quickly, it may be because the people taking them were at low risk to begin with, he says. "But on the other hand, people who adhere to medications over the long haul are the ones who tend to have the best prognosis and best health status," he says.

Wang says that since published data from statin studies for cholesterol control suggest that "each statin has a slightly different effect on [cholesterol], it is possible that each would also work differently on bone."

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