0
Original Investigation |

Statins and Musculoskeletal Conditions, Arthropathies, and Injuries

Ishak Mansi, MD1,2,3,10; Christopher R. Frei, PharmD, MSc4,6; Mary Jo Pugh, PhD5,7; Una Makris, MD8; Eric M. Mortensen, MD, MSc9
[+] 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.
Text Size: A A A
Published online

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.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Place holder to copy figure label and caption
Figure.
Study Cohort
Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Clinical Scenario

Users' Guides to the Medical Literature
Statin Dosing and LDL Levels

brightcove.createExperiences();