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October 18, 2000

Statin Drugs and the Risk of Fracture

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(15):1921-1922. doi:10.1001/jama.284.15.1921

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.