Statin Therapy Does Not Reduce Risk of Fracture

In an analysis of data from the JUPITER trial, higher baseline hs-CRP level was also not associated with an increased risk of incident fracture…

Osteoporosis is common among those suffering from cardiovascular disease. The two diseases are thought to share a common biological pathway involving inflammation as the main catalyst. Through observational studies, there have been suggestions that statin use is associated with a lower risk of fractures. Randomized trial data for this topic is insufficient.

One goal of the JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study was to determine whether statin therapy reduces the risk of fracture and, in a secondary analysis, whether baseline levels of the inflammatory biomarker high-sensitivity C-reactive protein (hs-CRP) are associated with the risk of fracture.

This study was a randomized, double-blind, placebo-controlled study enrolling 17,802 men older than 50 years and women older than 60 years with hs-CRP levels of at least 2mg/L. The participants were screened from 2003 to 2006 and observed prospectively for up to 5 years with a median follow-up of 1.9 years. Participants were randomized to receive rosuvastatin 20mg daily or placebo.

Throughout the study, there were a total of 431 incident fractures confirmed. Among participants taking rosuvastatin, 221 fractures were confirmed compared to 210 among those taking to placebo. The incidence of fractures in the rosuvastatin and placebo group was 1.20 and 1.14 per 100 person-years, respectively (adjusted HR, 1.06 [95% CI, 0.88-1.28]; P=.53). Overall, increasing baseline hs-CRP level was not associated with an increased risk of fractures (adjusted HR for each unit increase in hs-CRP tertile, 1.06 [95%CI, 0.94-1.20]; P for trend 0.34).

In conclusion, among men and women with elevated hs-CRP level enrolled in a large trial of rosuvastatin therapy for cardiovascular disease, statin therapy did not reduce the risk of fracture. Higher baseline hs-CRP level was not associated with an increased risk of incident fracture.

Practice Pearls:

• One aim of the JUPITER study was to evaluate whether statin therapy reduces risk for fracture.
• During the study, similar numbers of participants taking rosuvastatin 20mg and placebo suffered fractures (221 vs 210, respectively; P=0.53).
• Results indicated that statin therapy does not reduce the risk for fracture and higher baseline hs-CRP level was not associated with higher risk for fractures.

Peña JM, Aspberg S, MacFadyen J, Glynn RJ, Solomon DH, Ridker P. Statin Therapy and Risk of Fracture: Results From the JUPITER Randomized Clinical Trial. JAMA Intern Med. Published online December 01, 2014. doi:10.1001/jamainternmed.2014.6388.