In the Journals Plus

Statin use may lower fracture risk after stroke

Show Citation

July 5, 2018

Adults prescribed statin therapy after a stroke were less likely to sustain a fracture vs. similar patients not prescribed statin therapy, according to findings from a population-based study conducted in Taiwan.

“Stroke is a major risk factor for osteoporosis and fractures, owning to a significant loss of bone mineral density, gait disability, balance impairment, immobilization and increase in fall risk that occur after a stroke,” Shu-Man Lin, MD, of the department of physical medicine and rehabilitation at Buddhist Tzu Chi General Hospital in Hualien, Taiwan, and colleagues wrote in the study background. “Fractures, which are a common complication of stroke, can further reduce functional recovery, prolong disability and increase the mortality risk among stroke patients. Thus, it is imperative to develop strategies for osteoporosis and fracture prevention among stroke survivors.”

In a population-based, propensity score-matched study, Lin and colleagues analyzed data from 5,254 patients newly diagnosed with stroke and without a previous history of osteoporosis or fracture between 2000 and 2012, registered in Taiwan’s National Health Insurance Research Database. The cohort included 2,627 patients in the statin and nonstatin users, respectively. Researchers used Cox proportional hazard regression models according to statin use to evaluate the association between statin use and risk for the primary outcome, defined as poststroke osteoporosis, hip fracture and vertebral fracture.

During a mean follow-up of 4.2 years, 390 patients in the statin group and 535 in the nonstatin group sustained a hip or vertebral fracture or osteoporosis after their stroke, according to the researchers. Kaplan-Meier curves revealed a lower cumulative incidence of any event in the statin vs. the nonstatin group (35.1 vs. 48 per 1,000 person-years, respectively; P < .001).

Researchers found that poststroke statin use was associated with a lower overall risk for the combined primary outcome (adjusted HR = 0.66; 95% CI, 0.58-0.76).

In subanalyses, statin use was also associated with decreased risk for osteoporosis (aHR = 0.68; 95% CI, 0.58-0.79), hip fracture (aHR = 0.59; 95% CI, 0.47-0.75) and vertebral fracture (aHR = 0.73; 95% CI, 0.6-0.9).

Researchers also observed a dose-effect relationship between cumulative defined daily doses of statin use and decreased risk for the combined primary outcome. In patients with one to 90 cumulative defined daily doses of statins, adjusted HR was 0.96 (95% CI, 0.91-1.15), falling to 0.86 for patients with 91 to 263 cumulative defined daily doses (95% CI, 0.71-1.03) and 0.34 for patients with more than 365 cumulative defined daily doses (95% CI, 0.27-0.43).

“In our subanalyses for different statin cumulative doses, only patients with high [cumulative defined daily doses] of statin had a significant reduction in the risk of osteoporosis and fractures,” the researchers wrote. “These findings can be explained by the fact that it takes substantial doses/duration of statin use in order to observe the possible effects of statins on the related risk of osteoporosis/fractures.”

Results persisted in sensitivity analyses stratified by age, sex and stroke type, but results did not persist among patients who sustained a hemorrhagic stroke, according to the researchers, who added that this finding was likely due to an insufficient number of cases in this category. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.

itj+ Infographic

itj+ Perspective