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Lin TK, Pan LF, Jong GP. Correspondence on 'Concomitant use of oral glucocorticoids and proton pump inhibitors and risk of osteoporotic fractures among patients with rheumatoid arthritis: a population-based cohort study'. Ann Rheum Dis 2021; 82:e141. [PMID: 34039621 DOI: 10.1136/annrheumdis-2021-220453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Tsung-Kun Lin
- Department of Pharmacy, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Lung-Fa Pan
- Graduate Institute of Radiological Science, Central Taiwan University of Sciences and Technology, Taichung, Taiwan.,Department of Cardiology, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Gwo-Ping Jong
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan .,Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Chen HY, Su PY, Lin TK, Jong GP. Association between statin use and osteoporotic fracture in patients with chronic obstructive pulmonary disease: a population-based, matched case-control study. Lipids Health Dis 2020; 19:232. [PMID: 33143674 PMCID: PMC7641811 DOI: 10.1186/s12944-020-01412-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In the recent years, chronic obstructive pulmonary disease (COPD) has been found to be associated with a higher risk of new-onset osteoporotic fracture (NOF). However, the existence of such an association in the COPD patients receiving statin treatment remains unknown. The present study aimed to investigate the association between COPD and NOF in statin-treated patients. METHODS The present study was conducted over a period of 10 years (January 2004 to December 2013) in Taiwan. COPD patients receiving statin treatment were included in the statin user group, whereas the randomly selected statin non-users, with 1:1 matching for sex, age, index date, and Charlson Comorbidity Index, were included in the statin non-user group. The hazard ratio (HR) of NOFs in COPD patients was estimated between statin user and non-user groups. RESULTS A total of 86,188 cases were identified as the statin-treated patients, and 86,188 subjects were included in the control group of statin non-users. Initially, the risk of NOF was found to be higher among the statin users as compared to non-users [HR, 1.12; 95% confidence interval (CI), 1.01-1.25]. However, the calculation of risk for NOFs after the adjustment for age, sex, comorbidities, and concurrent medications indicated no association of NOF (HR, 0.81; 95% CI, 0.55-1.21) with COPD in patients receiving statin treatment as compared to statin non-users. CONCLUSION The results of the study provided first evidence for the absence of any association between COPD and NOFs in statin-treated patients during a follow-up period of 10 years. Thus, the findings of this study might support the hypothesis stating the potent pleiotropic effects of statins. In clinical practice, these drugs might prove beneficial for the patients with COPD.
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Affiliation(s)
- Hung-Yi Chen
- Department of Pharmacy, China Medical University, Taichung, Taiwan, Republic of China.,Department of Pharmacy, China Medical University Beigang Hospital, Yunlin County, Taiwan, Republic of China
| | - Pei-Yu Su
- Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Tsung-Kun Lin
- Department of Pharmacy, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Gwo-Ping Jong
- Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan, Republic of China.
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Mortensen SJ, Mohamadi A, Wright CL, Chan JJ, Weaver MJ, von Keudell A, Nazarian A. Medications as a Risk Factor for Fragility Hip Fractures: A Systematic Review and Meta-analysis. Calcif Tissue Int 2020; 107:1-9. [PMID: 32253446 DOI: 10.1007/s00223-020-00688-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/26/2020] [Indexed: 12/13/2022]
Abstract
Fragility hip fractures and their associated morbidity and mortality pose a global healthcare problem. Several pharmaceutical products have been postulated to alter bone architecture and contribute to fragility hip fractures. We searched four electronic databases from inception to September 2017. Inclusion criteria were the following: (1) adult patients with fragility hip fractures, (2) full text in English, (3) minimum one-year follow-up, and (4) reporting of at least one risk factor. To minimize heterogeneity among the studies, we performed subgroup analyses. Whenever heterogeneity remained significant, we employed random effect meta-analysis for data pooling. Thirty-eight studies were included, containing 1,244,155 subjects and 188,966 cases of fragility hip fractures. Following medications were significantly associated with fragility hip fractures: Antidepressants (OR 2.07, 95% CI 1.98-2.17), antiparkinsonian drugs (OR 2.21, 95% CI 1.15-4.24), antipsychotic drugs (OR 2.0, 95% CI 1.50-2.66), anxiolytic drugs (OR 1.44, 95% CI 1.19-1.75), benzodiazepines (OR 1.84, 95% CI 1.26-2.69), sedatives (OR 1.33, 95% CI 1.14-1.54), systemic corticosteroids (OR 1.65, 95% CI 1.37-1.99), H2 antagonists (OR 1.21, 95% CI 1.18-1.24), proton pump inhibitors (OR 1.41, 95% CI 1.16-1.71), and thyroid hormone (OR 1.29, 95% CI 1.13-1.47). Hormone replacement therapy with estrogen (HRT) was associated with decreased risk of hip fracture (OR 0.80, 95% CI 0.65-0.98). There are several medications associated with sustaining a fragility hip fracture. Medical interventions should be considered for patients on these medications, including information about osteoporosis and fracture prevention.
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Affiliation(s)
- Sharri J Mortensen
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Amin Mohamadi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Casey L Wright
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jimmy J Chan
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael J Weaver
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Arvind von Keudell
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
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Shi R, Mei Z, Zhang Z, Zhu Z. Effects of Statins on Relative Risk of Fractures for Older Adults: An Updated Systematic Review With Meta-Analysis. J Am Med Dir Assoc 2019; 20:1566-1578.e3. [PMID: 31395495 DOI: 10.1016/j.jamda.2019.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/17/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022]
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Leutner M, Matzhold C, Bellach L, Deischinger C, Harreiter J, Thurner S, Klimek P, Kautzky-Willer A. Diagnosis of osteoporosis in statin-treated patients is dose-dependent. Ann Rheum Dis 2019; 78:1706-1711. [PMID: 31558481 PMCID: PMC6900255 DOI: 10.1136/annrheumdis-2019-215714] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/27/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
Abstract
Objective Whether HMG-CoA-reductase inhibition, the main mechanism of statins, plays a role in the pathogenesis of osteoporosis, is not entirely known so far. Consequently, this study was set out to investigate the relationship of different kinds and dosages of statins with osteoporosis, hypothesising that the inhibition of the synthesis of cholesterol could influence sex-hormones and therefore the diagnosis of osteoporosis. Methods Medical claims data of all Austrians from 2006 to 2007 was used to identify all patients treated with statins to compute their daily defined dose averages of six different types of statins. We applied multiple logistic regression to analyse the dose-dependent risks of being diagnosed with osteoporosis for each statin individually. Results In the general study population, statin treatment was associated with an overrepresentation of diagnosed osteoporosis compared with controls (OR: 3.62, 95% CI 3.55 to 3.69, p<0.01). There was a highly non-trivial dependence of statin dosage with the ORs of osteoporosis. Osteoporosis was underrepresented in low-dose statin treatment (0–10 mg per day), including lovastatin (OR: 0.39, CI 0.18 to 0.84, p<0.05), pravastatin (OR: 0.68, 95% CI 0.52 to 0.89, p<0.01), simvastatin (OR: 0.70, 95% CI 0.56 to 0.86, p<0.01) and rosuvastatin (OR: 0.69, 95% CI 0.55 to 0.87, p<0.01). However, the exceeding of the 40 mg threshold for simvastatin (OR: 1.64, 95% CI 1.31 to 2.07, p<0.01), and the exceeding of a 20 mg threshold for atorvastatin (OR: 1.78, 95% CI 1.41 to 2.23, p<0.01) and for rosuvastatin (OR: 2.04, 95% CI 1.31 to 3.18, p<0.01) was related to an overrepresentation of osteoporosis. Conclusion Our results show that the diagnosis of osteoporosis in statin-treated patients is dose-dependent. Thus, osteoporosis is underrepresented in low-dose and overrepresented in high-dose statin treatment, demonstrating the importance of future studies’ taking dose-dependency into account when investigating the relationship between statins and osteoporosis.
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Affiliation(s)
- Michael Leutner
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Caspar Matzhold
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Luise Bellach
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Carola Deischinger
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Thurner
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria.,Santa Fe Institute, Santa Fe, New Mexico, USA.,IIASA, Laxenburg, Austria
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
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Lin TK, Liou YS, Lin CH, Chou P, Jong GP. High-potency statins but not all statins decrease the risk of new-onset osteoporotic fractures: a nationwide population-based longitudinal cohort study. Clin Epidemiol 2018; 10:159-165. [PMID: 29403315 PMCID: PMC5779306 DOI: 10.2147/clep.s145311] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Statins have been linked to new-onset osteoporotic fractures (NOFs), and different statins may alter the risk for the development of NOFs. Aim In this study, we investigated the association between different statins and the development of NOFs. Patients and methods This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance, including case patients with NOFs from January 2004 to December 2013 and non-NOF subjects. We estimated the hazard ratios (HRs) of NOFs associated with statin use. Nonuser subjects served as the reference group. Results A total of 44,405 patients with NOFs were identified from among 170,533 patients with hyperlipidemia during the study period. The risk of developing NOFs after adjusting for age, sex, comorbidities, and concurrent medication use was lower among users of atorvastatin (HR, 0.77; 95% CI, 0.71-0.84) and rosuvastatin (HR, 0.72; 95% CI, 0.64-0.81) than among simvastatin users. Lovastatin, pravastatin, fluvastatin, and pitavastatin were not associated with the risk of developing NOFs compared with simvastatin users. Conclusion This study supports previous reports regarding a beneficial effect of statin use and NOF risk, but not all statins. Patients taking atorvastatin or rosuvastatin were at lower risk of developing NOFs compared with simvastatin users during the 10-year follow-up. Other statins such as pravastatin, fluvastatin, lovastatin, and pitavastatin were not associated with NOFs. This study also highlighted that high-potency statin has a dose-response effect on lower NOF risk.
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Affiliation(s)
- Tsung-Kun Lin
- Department of Pharmacy, Taoyuan Armed Forces General Hospital, Taoyuan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei
| | - Yi-Sheng Liou
- Department of Family Medicine and Geriatrics, Taichung Veteran General Hospital, Taichung.,School of Public Health, National Defense Medical Center, Taipei
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei
| | - Gwo-Ping Jong
- Division of Internal Cardiology, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan, Republic of China
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Vangala C, Lenihan CR, Montez-Rath ME, Nair SS, Navaneethan SD, Ramanathan V, Winkelmayer WC. Statin use and hip fractures in U.S. kidney transplant recipients. BMC Nephrol 2017; 18:145. [PMID: 28460645 PMCID: PMC5412039 DOI: 10.1186/s12882-017-0559-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/19/2017] [Indexed: 11/25/2022] Open
Abstract
Background Basic and translational research supports beneficial effects of statins on bone metabolism. Clinical studies suggest that statin use may reduce the risk of hip fractures in the general population. Whether statin use is associated with hip fracture risk in kidney transplant recipients, a particularly high-risk group for this outcome, is unknown. Methods From the U.S. Renal Data System (2007–2011), we identified all hip fracture events recorded in Medicare billing claims of first-time kidney transplant recipients. We then matched all cases to an unlimited number of controls on age (±3 years), sex, race (black vs. non-black), and time since transplant. Cases and controls were required to have >1 year of Medicare Parts A + B + D coverage and be without a recorded history of hip fracture. We ascertained any statin use in the previous year and defined adherent statin use as those who had filled prescriptions for statins to cover >80% of days in that year (proportion of days covered, PDC). We ascertained several potential confounders (demographics, comorbidities, BMI, transplant-related factors) and applied conditional logistic regression with multiple imputation for missing data to estimate odds ratios (OR) and 95% confidence intervals (CI). Results We identified 231 hip fracture cases (mean age 51.8 years; 53% female; 11.3% black; 6.9 years from transplant, and 9.9 years from ESRD) and 15,575 matched controls. Any prior statin use was present in 64.1% of cases and 60.3% of controls with 37.2% of cases and 33.9% of controls being found adherent. Unadjusted conditional logistic regression showed an OR of 1.17 (0.89-1.54) for any statin use, and a fully-adjusted OR of 0.89 (0.67-1.19). Compared with statin non-users, the adjusted OR for patients with lesser adherence (PDC ≤80%) and those with greater adherence (PDC >80%) were 0.93 (0.66-1.31) and 0.87 (0.63-1.20), respectively. Conclusion Statin use was not associated with hip fracture risk in first-time kidney transplant recipients. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0559-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chandan Vangala
- Baylor College of Medicine, Section of Nephrology, One Baylor Plaza, BCM 620 - 11D32.5, Houston, TX, 77030, USA
| | - Colin R Lenihan
- Division of Nephrology, Stanford University School of Medicine, 777 Welch Road Suite DE, Palo Alto, CA, 94304, USA.
| | - Maria E Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 1070 Arastradero Road # 3C11C, Palo Alto, CA, 94304, USA
| | | | - Sankar D Navaneethan
- Baylor College of Medicine, Section of Nephrology, One Baylor Plaza, Ste 100-37D, Houston, TX, 77030, USA
| | - Venkat Ramanathan
- Baylor College of Medicine, Section of Nephrology, One Baylor Plaza, BCM 620 - 11D32.5, Houston, TX, 77030, USA.,Section of Nephrology, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, #111-J, Houston, TX, 77030, USA
| | - Wolfgang C Winkelmayer
- Baylor College of Medicine, Section of Nephrology, One Baylor Plaza, BCM 395, Houston, TX, 77030, USA
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An T, Hao J, Sun S, Li R, Yang M, Cheng G, Zou M. Efficacy of statins for osteoporosis: a systematic review and meta-analysis. Osteoporos Int 2017; 28:47-57. [PMID: 27888285 DOI: 10.1007/s00198-016-3844-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/14/2016] [Indexed: 12/14/2022]
Abstract
Our meta-analysis assessed the efficacy of statins on the risk of fracture, bone mineral density (BMD), and the markers of bone metabolism by collecting data from 33 clinical trials. We found that statin treatment was associated with bone metabolism. And statins seemed to be more effective on male patients with osteoporosis. The efficacy of statins for the treatment of osteoporosis has been controversial in previous studies and meta-analyses. Our meta-analysis was conducted to examine in detail the efficacy of statins on osteoporosis. We searched PubMed, Embase, and the Cochrane Library databases for clinical trials from inception to May 2016. We included studies that described the effect of statins on the risk of fracture, BMD, or bone turnover markers. Moreover, we also conducted subgroup analyses according to the skeleton site, patient gender, and length of follow-up. A total of 33 studies which included 23 observational studies (16 cohort studies and 7 case-control studies) and 10 randomized controlled trials (RCTs) were evaluated. These 33 studies included 314,473 patients in statin group and 1,349,192 patients in control group. Statins decreased the risk of overall fractures (OR = 0.81, 95% CI 0.73-0.89) and hip fractures (OR = 0.75, 95% CI 0.60-0.92). Furthermore, the use of statins was associated with increased BMD at the total hip (standardized mean difference (SMD) = 0.18, 95% CI 0.00-0.36) and lumbar spine (SMD = 0.20, 95% CI 0.07-0.32) and improved the bone formation marker, osteocalcin (OC) (SMD = 0.21, 95% CI 0.00-0.42). However, there was no positive effect on vertebral fractures, upper extremity fractures, BMD at the femoral neck, bone-specific alkaline phosphatase (BALP), and serum C-terminal peptide of type I collagen (S-CTX). Also, compared with male subgroups, the effect on female subgroups was only slightly positive or of no statistical significance. Our meta-analysis indicates that statin treatment may be associated with a decreased risk of overall fractures and hip fractures, an increased BMD at the total hip, BMD at the lumbar spine, and OC. Moreover, our results also show that statin treatment may have a greater effect on male patients than on female patients.
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Affiliation(s)
- T An
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - J Hao
- Department of Blood Purification, General Hospital of Shenyang Military Command, Shenyang, 110016, China
| | - S Sun
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - R Li
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - M Yang
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - G Cheng
- Department of Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - M Zou
- Department of Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016, China.
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