Statin use reduces incident hip fractures among older Chinese people with type 2 diabetes, independent of mean haemoglobin A1c and duration of diabetes

Abstract

Introduction: Statins are associated with reduced risks of hip fractures in the general population. People with type 2 diabetes have increased fracture risk related to its unique bone pathophysiology and level of glycaemia. We therefore studied the effect of statins on incident hip fractures in people with type 2 diabetes. Methods: Chinese individuals with type 2 diabetes aged ≥60 years were identified from electronic health records in Hong Kong between 2008 and 2012 and observed for incident hip fractures. Participants were categorised into ‘never users’, ‘long-term users’, and ‘new users’ of statin. Cumulative defined daily doses (cDDD) of statins were calculated. Multivariable Cox regression analysis was used to calculate the adjusted hazard ratio (aHR) of incident hip fractures with the use of statins. Results: Among the 60 825 participants, both ‘long-term users’ and ‘new users’ of statin had less incident hip fractures compared with ‘never users’ (aHR=0.57 and 0.60 respectively, both P<0.001). Comparison between ‘never users’ and ‘new users’ with propensity score matching for baseline characteristics revealed a comparable reduction in incident hip fractures among ‘new users’ (aHR=0.50, P<0.001). A dose-response relationship was observed, with more risk reduction in the quartiles with higher cDDD of statins (aHR=0.49 for Q2, aHR=0.37 for Q3, aHR=0.23 for Q4; all P<0.001 compared with ‘never users’). These protective effects were independent of haemoglobin A1c and the duration of diabetes. Conclusion: Statin use reduces incident hip fractures among older Chinese people with type 2 diabetes, in a dose-response manner.