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Statins and Musculoskeletal Conditions, Arthropathies, and Injuries
ONLINE FIRST
Ishak Mansi, MD; Christopher R. Frei, PharmD, MSc; Mary Jo Pugh, PhD;
Una Makris, MD; Eric M. Mortensen, MD, MSc
JAMA Intern Med. 2013;():1-9. doi:10.1001/jamainternmed.2013.6184


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.


http://archinte.jamanetwork.com/arti...icleid=1691918

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Rod