Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
To the Editor: Dr Meier and colleagues1 suggest that statins may lower the risk of fracture.
Their results are consistent with the finding that statins increase bone morphogenetic
protein-2 (BMP-2) in rodent and human cells and increase the rate of bone
formation in rodents by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA)
reductase.2 However, pravastatin has recently
been shown to be ineffective at increasing BMP-2 or stimulating bone formation.3 This may be due to the different physicochemical
properties and relative hepatoselectivity of pravastatin.4
Indeed, pravastatin binds less strongly to plasma proteins than do lovastatin,
simvastatin, or fluvastatin.4 Excluding
pravastatin from the analysis may increase the association between statins
and decreased risk of fracture. Although Meier et al indicate that each of
the statins was individually associated with a decreased fracture risk it
would be of interest to know how the reduction in risk by pravastatin compares
with the other statins.
El-Sohemy A. Statin Drugs and the Risk of Fracture. JAMA. 2000;284(15):1921-1922. doi:10.1001/jama.284.15.1921