Effects of statins on bone markers bone mineral density and fractures. Possible role in osteoporosis treatment

Several clinical trials have shown an association between osteoporosis and an increase in cardiovascular mortality, especially in patients with vertebral fracture. In addition to their action on a decrease in cholesterol levels and a reduction of mortality in individuals with ischemic heart disease, statins can have a beneficial effect on other chronic diseases, including osteoporosis. Statins can have anabolic and anticatabolic effects on bone. Mundy published the first in vitro study with animals and demonstrated an anabolic effect of the statins on bone. On the other hand, through its action on the 3-hydroxy-3-methylglutarylcoenzyme A (HMG-CoA) reductase, it inhibits the mevalonate synthesis by reducing the prenylation of glutamyltranspeptidase (Ras, Rho, Rai, Rab) necessary to osteoclast activity and the decrease in the apoptosis, which results in a decrease in bone resorption. Studies on humans have alnalyzed the effect of statins on bone remodeling markers, bone mass fracture risks. Retrospective studies (case-control, cohort studies) followed, which showed a beneficial effect of the statins on the reduction of fractures, although not all the results are consistent. The prospective studies have been undertaken with a small number of patients and only the bone mineral density has been evaluated. A meta-analysis of prospective and observational studies has shown a protective effect on hip fracture (OR: 0.43, 95 % CI 0.25-0.75) and non-vertebral fracture (OR: 0.69, 95 % CI 0.75-0.88). The objective of this article is to review the available evidence, experimental and clinical, of the effect of statins on bone mass and the reduction of fractures. These drugs may be an alternative for the treatment of osteoporosis, keeping in mind that osteoporosis and atherosclerosis affect similar age groups.