Scranton Richard E, Young Melissa, Lawler Elizabeth, Solomon Daniel, Gagnon David, Gaziano J Michael
Massachusetts Veterans Epidemiology Research Information Center, 150 S Huntington Ave, Mail Stop MAV 151, Boston, MA 02130, USA.
Arch Intern Med. 2005 Sep 26;165(17):2007-12. doi: 10.1001/archinte.165.17.2007.
Whether statins reduce the risk of fractures is still contested. Several studies support a favorable association, whereas post hoc analyses of statin-randomized trials have failed to find a benefit. We sought to assess this possible relationship in a large population of elderly, predominantly male veterans.
We established the study population using all health care encounters and services from patients who received care in the New England Veterans Affairs health care system between January 1998 and June 2001. According to evidence from the literature, covariates that would affect the risk of fractures were included in the final model, as were medications that were clinically meaningful and significant in univariate models and the Charlson Comorbidity Index as a surrogate for general health. We also conducted a similar analysis among new statin users. We used pooled logistic regression to assess for significant associations.
Of the 91 052 patients in the final cohort, 28 063 were prescribed statins and 2195 were prescribed nonstatin lipid-lowering medications. In the adjusted analyses, statin use was associated with a 36% (odds ratio, 0.64; 95% confidence interval, 0.58-0.72) reduction in fracture risk when compared with no lipid-lowering therapy and a 32% (odds ratio, 0.67; 95% confidence interval, 0.50-0.91) reduction when compared with nonstatin lipid-lowering therapy. Similar findings were found for the new statin user group.
We have provided yet another study in a unique population of mostly male veterans that found a significant reduction in fractures among statin users. More studies need to be performed to confirm or refute our findings.
他汀类药物是否能降低骨折风险仍存在争议。多项研究支持两者存在有益关联，而他汀类药物随机试验的事后分析未能发现其益处。我们试图在以男性退伍军人为主的大量老年人群中评估这种可能的关系。
我们利用1998年1月至2001年6月期间在新英格兰退伍军人事务医疗系统接受治疗的患者的所有医疗接触和服务来确定研究人群。根据文献证据，最终模型纳入了会影响骨折风险的协变量、在单变量模型中具有临床意义且显著的药物以及作为总体健康替代指标的查尔森合并症指数。我们还对新使用他汀类药物的患者进行了类似分析。我们使用汇总逻辑回归来评估显著关联。
在最终队列的91052名患者中，28063人被开具了他汀类药物，2195人被开具了非他汀类降脂药物。在调整分析中，与未进行降脂治疗相比，使用他汀类药物与骨折风险降低36%（比值比，0.64；95%置信区间，0.58 - 0.72）相关，与使用非他汀类降脂药物相比，骨折风险降低32%（比值比，0.67；95%置信区间，0.50 - 0.91）。新使用他汀类药物的患者组也有类似发现。
我们在以男性退伍军人为主的独特人群中进行了另一项研究，发现使用他汀类药物的患者骨折风险显著降低。需要进行更多研究来证实或反驳我们的发现。
