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Statin Use, Clinical Fracture, and Bone Density in Postmenopausal Women: Results from the Women's Health Initiative Observational Study

Andrea Z. LaCroix, PhD; Jane A. Cauley, DrPH; Mary Pettinger, MS; Judith Hsia, MD; Douglas C. Bauer, MD; Joan McGowan, PhD; Zhao Chen, PhD; Cora E. Lewis, MD; S. Gene McNeeley, MD; Maureen D. Passaro, MD; and Rebecca D. Jackson, MD
[+] Article and Author Information

From Women's Health Initiative Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Pittsburgh, Pittsburgh, Pennsylvania; George Washington University and Medlantic Research Institute, Washington, DC; University of California, San Francisco, San Francisco, California; National Institute of Arthritis and Musculoskeletal Diseases, National Institutes of Health, Bethesda, Maryland; University of Arizona, Tucson, Arizona; University of Alabama at Birmingham, Birmingham, Alabama; Wayne State University, Detroit, Michigan; and Ohio State University, Columbus, Ohio.


Grant Support: By the National Institutes of Health contracts for the Women's Health Initiative Clinical Centers and Clinical Coordinating Center.

Potential Financial Conflicts of Interest:Consultancies: A.Z. LaCroix (Pfizer); J. Hsia (Merck); D.C. Bauer (AstraZeneca, Pfizer); R.D. Jackson (Proctor & Gamble, Merck); Honoraria: J.A. Cauley (Eli Lilly, Proctor & Gamble); J. Hsia (Pfizer); R.D. Jackson (Proctor & Gamble, Merck); Stock ownership or options (other than mutual funds): R.D. Jackson (Proctor & Gamble); Grants received: A.Z. LaCroix (Merck, Pfizer); J.A. Cauley (Merck, Eli Lilly, Pfizer); J. Hsia (Merck, Pfizer); D.C. Bauer (Merck, Proctor & Gamble); C.E. Lewis (Eli Lilly, Pfizer); R.D. Jackson (Proctor & Gamble, Merck); Grants pending: J.A. Cauley (Novartis); C.E. Lewis (Novartis).

Requests for Single Reprints: Andrea Z. LaCroix, PhD, Women's Health Initiative Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, MP-1002, PO Box 19024, Seattle, WA 98109-1024.

Current Author Addresses: Dr. LaCroix and Ms. Pettinger: Women's Health Initiative Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, MP-1002, PO Box 19024, Seattle, WA 98109.

Dr. Cauley: Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, 130 DeSoto Street, Room A524, Pittsburgh, PA 15261.

Dr. Hsia: George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC 20037.

Dr. Bauer: University of California, San Francisco, 74 New Montgomery, Suite 600, San Francisco, CA 94105.

Dr. Chen: University of Arizona, 2501 East Lee Street, Tucson, AZ 85716.

Dr. Lewis: University of Alabama at Birmingham, 1717 11th Avenue South, Room 614, Birmingham, AL 35205.

Dr. McNeeley: Wayne State University, 4707 St. Antoine, Detroit, MI 48201.

Dr. Passaro: Medstar Research Institute, 650 Pennsylvania Avenue SE, Suite 50, Washington, DC 20003.

Dr. Jackson: The Ohio State University, 198 McCampbell, 1581 Dodd Drive, Columbus, OH 43210.

Author Contributions: Conception and design: A.Z. LaCroix, J.A. Cauley, J. McGowan, C.E. Lewis, R.D. Jackson.

Analysis and interpretation of the data: A.Z. LaCroix, J.A. Cauley, M. Pettinger, J. Hsia, D.C. Bauer, J. McGowan, Z. Chen, R.D. Jackson, S.G. McNeeley.

Drafting of the article: A.Z. LaCroix.

Critical revision of the article for important intellectual content: A.Z. LaCroix, J.A. Cauley, J. Hsia, D.C. Bauer, Z. Chen, C.E. Lewis, M.D. Passaro, R.D. Jackson, S.G. McNeeley.

Final approval of the article: A.Z. LaCroix, J.A. Cauley, M. Pettinger, J. Hsia, D.C. Bauer, J. McGowan, Z. Chen, C.E. Lewis, M.D. Passaro, R.D. Jackson, S.G. McNeeley.

Provision of study materials or patients: J. Hsia, C.E. Lewis, M.D. Passaro.

Statistical expertise: A.Z. LaCroix, M. Pettinger.

Obtaining of funding: C.E. Lewis.

Administrative, technical, or logistic support: A.Z. LaCroix, C.E. Lewis.

Collection and assembly of data: A.Z. LaCroix, J.A. Cauley, J. Hsia, C.E. Lewis, R.D. Jackson.


Ann Intern Med. 2003;139(2):97-104. doi:10.7326/0003-4819-139-2-200307150-00009
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Among the 93 716 women in the total cohort, 7846 (8.4%) were currently using statin medication at baseline; 1844 (2%) had used their current statin medication for more than 3 years, 3416 (3.6%) for 1 to 3 years, and 2586 (2.8%) for less than 1 year. The prevalence rates of use of statin agents were simvastatin (2.6%), lovastatin (2.1%), pravastatin (1.9%), fluvastatin (1.0%), and atorvastatin (0.8%). According to potency classification, 2526 women (3.1%) used a low-potency statin, 1516 (1.9%) used a medium-potency statin, and 2720 (3.3%) used a high-potency statin. Women currently using statin medication at baseline were older than nonusers (mean age, 65.8 years vs. 63.4 years, respectively), had higher body mass index (28.4 kg/m2 vs. 27.2 kg/m2, respectively), and were more likely to have a history of myocardial infarction or angina (Table 1). Concurrent use of thiazide diuretics was also more common among statin users. Hormone replacement therapy was used slightly less often among statin users than nonusers (40.4% vs. 46.0%, respectively). Among current hormone users, the duration of hormone use was similar for statin users (8.4 years) and nonusers (8.3 years). Other baseline characteristics were similar for statin users and nonusers, including race or ethnicity, history of fracture, alcohol consumption, smoking, time spent walking, and total daily calcium intake (Table 1). Although the differences by statin use were small, many of these comparisons were nonetheless statistically different because of the large number of women in the cohort.

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Figure.
Age-adjusted rates of fracture per 1000 person-years according to duration of statin use among postmenopausal women 50 to 79 years of age in the Women's Health Initiative Observational Study.
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Summary for Patients

Relationship between Use of Cholesterol-Lowering Drugs (Statins) and Osteoporosis in Women after Menopause

The summary below is from the full report titled “Statin Use, Clinical Fracture, and Bone Density in Postmenopausal Women: Results from the Women's Health Initiative Observational Study.” It is in the 15 July 2003 issue of Annals of Internal Medicine (volume 139, pages 97-104). The authors are A.Z. LaCroix, J.A. Cauley, M. Pettinger, J. Hsia, D.C. Bauer, J. McGowan, Z. Chen, C.E. Lewis, S.G. McNeeley, M.D. Passaro, and R.D. Jackson.

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