Statins and Musculoskeletal Conditions, Arthropathies, and Injuries

JAMA Intern Med. 2013 Jul 22;173(14):1-10. 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Cohort Studies
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*
  • Joint Diseases / chemically induced
  • Joint Diseases / epidemiology*
  • Joint Dislocations / epidemiology
  • Logistic Models
  • Male
  • Matched-Pair Analysis
  • Middle Aged
  • Muscle, Skeletal / injuries*
  • Musculoskeletal Diseases / chemically induced
  • Musculoskeletal Diseases / epidemiology*
  • Pain / chemically induced
  • Pain / epidemiology
  • Propensity Score
  • Retrospective Studies
  • Sprains and Strains / epidemiology

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors