Department of Orthopedics, Xinxiang Central Hospital, Xinxiang, Henan Province, China.
Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Anorectal Disease Institute of Shuguang Hospital, Shanghai, China.
J Am Med Dir Assoc. 2019 Dec;20(12):1566-1578.e3. doi: 10.1016/j.jamda.2019.06.027. Epub 2019 Aug 5.
Basic and translational studies have found statin treatment may have beneficial effects on bone metabolism; however, whether statins reduce the risk of fractures in older adults is still in debate. Therefore, we aimed to summarize the up-to-date evidence on risk of fracture among older individuals with statin use.
Systematic literature review and meta-analysis.
Twenty-one observational studies and 2 randomized controlled trials (RCTs) comprising 1,783,123 participants aged at least 50 years were retrieved from PubMed, Embase, and the Cochrane Library.
We estimated summary relative risks (RRs) with 95% confidence intervals (CIs) using the random-effects model. Subgroup analysis was performed to explore the potential source of heterogeneity.
Meta-analysis of observational studies suggested that statin treatment was significantly associated with reduced risk of all fractures (RR 0.80, 95% CI 0.72-0.88), among which hip fracture (RR 0.73, 95% CI 0.64-0.82) and lower extremity fracture (RR 0.69, 95% CI 0.54-0.88) showed consistent results, whereas no significant decreased risk was observed with respect to other fracture sites. Subgroup analyses showed that among the statin users, fracture risk was reduced in both genders, older adults ≥50 years old, those with short drug duration (< year) or medium to high statin dose (>90 defined daily dose), those taking atorvastatin, and in Europeans and Americans. Meta-analysis of RCTs revealed no significant effect of statin treatment on the risk of fractures (RR 1.00, 95% CI 0.87-1.15).
Overall, the findings of this updated meta-analysis indicated no solid evidence supporting that statins have a beneficial effect associated with reduced risk of fractures for older adults. Our findings should be further confirmed in future larger population-based prospective cohort studies or well-designed RCTs.
基础和转化研究发现，他汀类药物治疗可能对骨骼代谢有益；然而，他汀类药物是否降低老年人骨折风险仍存在争议。因此，我们旨在总结目前关于他汀类药物使用者中老年人骨折风险的最新证据。
系统文献回顾和荟萃分析。
从 PubMed、Embase 和 Cochrane 图书馆检索到 21 项观察性研究和 2 项随机对照试验（RCT），共纳入 1783123 名年龄至少 50 岁的参与者。
我们使用随机效应模型估计汇总相对风险（RR）及其 95%置信区间（CI）。进行亚组分析以探索潜在的异质性来源。
观察性研究的荟萃分析表明，他汀类药物治疗与所有骨折风险降低显著相关（RR 0.80，95%CI 0.72-0.88），其中髋部骨折（RR 0.73，95%CI 0.64-0.82）和下肢骨折（RR 0.69，95%CI 0.54-0.88）结果一致，而其他骨折部位未见骨折风险显著降低。亚组分析表明，在他汀类药物使用者中，男性和女性、年龄≥50 岁、药物使用时间较短（<1 年）或中高他汀剂量（>90 个定义日剂量）、使用阿托伐他汀以及欧洲人和美国人的骨折风险均降低。RCT 的荟萃分析显示，他汀类药物治疗对骨折风险无显著影响（RR 1.00，95%CI 0.87-1.15）。
总体而言，本更新荟萃分析的结果表明，没有确凿证据支持他汀类药物对老年人骨折风险降低有益。我们的发现应在未来更大的基于人群的前瞻性队列研究或精心设计的 RCT 中进一步证实。
