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Original Investigation
July 22, 2013

Statins and Musculoskeletal Conditions, Arthropathies, and Injuries

Author Affiliations
  • 1Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
  • 2Department of Medicine, Uniformed Service University of Health Sciences, Bethesda, Maryland
  • 3Department of Medicine, The University of Texas Health Science Center, San Antonio
  • 4Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center, San Antonio
  • 5Department of Epidemiology and Biostatistics, The University of Texas Health Science Center, San Antonio
  • 6College of Pharmacy, The University of Texas, Austin
  • 7South Texas Veterans Affairs Health Care System, San Antonio
  • 8Division of Rheumatic Diseases, Department of General Internal Medicine, Veterans Affairs North Texas Health Care System and The University of Texas Southwestern Medical Center, Dallas
  • 9Department of General Internal Medicine, Veterans Affairs North Texas Health Care System and The University of Texas Southwestern Medical Center, Dallas
  • 10now with the Department of General Internal Medicine, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center
JAMA Intern Med. 2013;173(14):1318-1326. doi:10.1001/jamainternmed.2013.6184
Abstract

Importance  Statin use may be associated with increased musculoskeletal adverse events, especially in physically active individuals.

Objective  To determine whether statin use is associated with musculoskeletal conditions, including arthropathy and injury, in a military health care system.

Design  A retrospective cohort study with propensity score matching.

Setting  San Antonio Military Multi-Market.

Participants  Tricare Prime/Plus beneficiaries evaluated from October 1, 2003, to March 1, 2010.

Interventions  Statin use during fiscal year 2005. On the basis of medication fills, patients were divided into 2 groups: statin users (received a statin for at least 90 days) and nonusers (never received a statin throughout the study period).

Main Outcomes and Measures  Using patients’ baseline characteristics, we generated a propensity score that was used to match statin users and nonusers; odds ratios (ORs) were determined for each outcome measure. Secondary analyses determined adjusted ORs for all patients who met study criteria and a subgroup of patients with no comorbidities identified using the Charlson Comorbidity Index. Sensitivity analysis further determined adjusted ORs for a subgroup of patients with no musculoskeletal diseases at baseline and a subgroup of patients who continued statin therapy for 2 years or more. The occurrence of musculoskeletal conditions was determined using prespecified groups of International Classification of Diseases, Ninth Revision, ClinicalModification codes: Msk1, all musculoskeletal diseases; Msk1a, arthropathies and related diseases; Msk1b, injury-related diseases (dislocation, sprain, strain); and Msk2, drug-associated musculoskeletal pain.

Results  A total of 46 249 individuals met study criteria (13 626 statin users and 32 623 nonusers). Of these, we propensity score–matched 6967 statin users with 6967 nonusers. Among matched pairs, statin users had a higher OR for Msk1 (OR, 1.19; 95% CI, 1.08-1.30), Msk1b (1.13; 1.05-1.21), and Msk2 (1.09; 1.02-1.18); the OR for Msk1a was 1.07 (0.99-1.16; P = .07). Secondary and sensitivity analyses revealed higher adjusted ORs for statin users in all outcome groups.

Conclusions and Relevance  Musculoskeletal conditions, arthropathies, injuries, and pain are more common among statin users than among similar nonusers. The full spectrum of statins’ musculoskeletal adverse events may not be fully explored, and further studies are warranted, especially in physically active individuals.

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