Osteoporos Int. 2026 Apr 15. doi: 10.1007/s00198-026-08021-6. Online ahead of print.
ABSTRACT
Chronic kidney disease patients face increased osteoporosis and fracture risk. High-potency statins were associated with lower osteoporosis incidence but also with higher long-term fracture incidence in this observational study. These findings highlight the need for tailored statin use and proactive fracture monitoring in CKD populations for optimal bone health management.
PURPOSE: Chronic kidney disease (CKD) affects approximately 850 million people worldwide and is associated with increased risks of cardiovascular events and fractures. The differential effects of statin potency on bone health in CKD patients remain incompletely understood.
METHODS: This retrospective cohort study used the TriNetX US Collaborative Network to identify adults with CKD stages 3 or 4 initiating statin therapy, categorized into high-potency (atorvastatin 40-80 mg, rosuvastatin 20-40 mg) and low-potency groups. After 1:1 propensity score matching, three primary outcomes were evaluated: new osteoporosis diagnosis, anti-osteoporotic medication initiation, and incident fractures, assessed at 3-12 months and beyond 12 months. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox and competing risk regression models.
RESULTS: Among 873,180 matched patients, high-potency statins were associated with a 20.0% reduction in osteoporosis diagnosis (HR 0.80; 95% CI 0.78-0.82) and 24.9% fewer anti-osteoporotic medication prescriptions (HR 0.75; 95% CI 0.73-0.78) during 3-12 months, with associations persisting beyond 12 months. Fracture risk did not differ at 3-12 months (HR 0.99; 95% CI 0.96-1.02); but increased beyond 12 months (HR 1.13; 95% CI 1.11-1.15).
CONCLUSIONS: High-potency statins are associated with lower osteoporosis diagnosis rates and fewer anti-osteoporotic medication prescriptions in CKD stages 3 and 4. The increased long-term fracture risk may reflect a diagnostic gap wherein lower osteoporosis detection contributes to under-treatment of bone fragility. Prospective randomized controlled trials with bone-specific endpoints are warranted to confirm these findings.
PMID:41984206 | DOI:10.1007/s00198-026-08021-6