Rejnmark L, Vestergaard P, Mosekilde L
Department of Endocrinology and Metabolism, Aarhus University Hospital, Aarhus Sygehus, Tage Hansens Gade 2, Aarhus C, DK-8000 Denmark.
Calcif Tissue Int. 2006 Jul;79(1):27-36. doi: 10.1007/s00223-006-0024-4. Epub 2006 Jul 24.
Discrepant results have been reported on association between treatment with lipid lowering drugs and fracture risk. Several studies have failed to demonstrate an effect of statins on bone mineral density. Therefore, the epidemiological findings of a reduced fracture risk may be due to selections bias, e.g. a healthy drug user effect. If so, the reduced fracture risk is most likely independent of type of lipid lowering drug.
We assessed fracture risk in users of various lipid-lowering drugs.
In a case-control design, we compared 124,655 fracture cases with 373,962 age- and gender-matched controls. We used computerized registers to assess individual drug use and related these data to individual fracture data and information on potential confounders.
Use of statins was associated with a reduced risk of any fracture (adj. OR 0.87; 95% CI, 0.83-0.92) and hip fractures (adj. OR 0.57; 95% CI, 0.48-0.69). Risk of hip fracture decreased with increased accumulated dose of statins. This was true in men and in women and in subjects younger and older than 65 years of age. However, fracture risk was not reduced in patients treated with pravastatin (adj. OR 1.02; 95% CI, 0.89-1.17) or non-statin lipid lowering drugs (adj. OR 0.99; 95% CI, 0.86-1.15).
The reduced fracture risk in users of lipid lowering drugs is apparently specifically related to users of non-pravastatin statins. Our findings do not support the hypothesis of a healthy drug user effect as an explanation for the reduced fracture risk in users of statins.
关于降脂药物治疗与骨折风险之间的关联，已有相互矛盾的研究结果报道。多项研究未能证实他汀类药物对骨密度有影响。因此，骨折风险降低这一流行病学研究结果可能归因于选择偏倚，例如健康药物使用者效应。如果是这样，骨折风险降低很可能与降脂药物的类型无关。
我们评估了各类降脂药物使用者的骨折风险。
采用病例对照设计，我们将124,655例骨折病例与373,962例年龄和性别匹配的对照进行了比较。我们使用计算机化登记系统评估个体药物使用情况，并将这些数据与个体骨折数据以及潜在混杂因素信息相关联。
使用他汀类药物与任何骨折风险降低相关（校正比值比[adj. OR]为0.87；95%置信区间[CI]，0.83 - 0.92）以及髋部骨折风险降低相关（校正比值比为0.57；95%置信区间，0.48 - 0.69）。髋部骨折风险随他汀类药物累积剂量增加而降低。在男性和女性以及年龄小于和大于65岁的受试者中均如此。然而，使用普伐他汀治疗的患者骨折风险未降低（校正比值比为1.02；95%置信区间，0.89 - 1.17），使用非他汀类降脂药物治疗的患者骨折风险也未降低（校正比值比为0.99；95%置信区间，0.86 - 1.15）。
降脂药物使用者骨折风险降低显然与非普伐他汀类他汀药物使用者特别相关。我们的研究结果不支持健康药物使用者效应这一假说作为他汀类药物使用者骨折风险降低的解释。
