Statins and osteoporosis

Dealing with both here... from what I've read, the evidence on statins and bone isn't really definitive yet - most of the research is based on lab studies and observational data, which don't always translate cleanly to real world outcomes.

I'm on rosuvastatin 5mg (+ezetimibe) to keep my LDL very low. Worth noting, i was on statin for about a year before I was diagnosed with OP, so it's unlikely the statin was a contributing factor for me. That said, I'm still not a great example to go by either way, since I then went on Forteo then HRT - two pretty powerful medications that make it impossible to isolate any statin effect on my bones.

The low dose vs high dose angle you mentioned is interesting, and worth discussing with your doctor!

@mayblin interested in this. Hoping someone chimes in with knowledge about statins and bone health. Ty

@mayblin I was just prescribed Rosuvastatin 5mg by my new pcp. Do you space the statin out from calcium and/or magnesium supplements. Do you space the statin from calcium and/or magnesium foods? Neither the pcp nor the pharmacist mentioned this but as I was reading about the med and read this may be an issue. Thanks!

This is interesting to me because I have severe osteoporosis, worse in my spine at -4.1. I am 76, no history of fracture, and not on any bone meds (which I hope to avoid).

I'm on the borderline regarding the need for a statin. I had a coronary calcium CT to help determine if I should start on a statin. I had a very low score (8), but since it wasn't zero, my doctor prescribed 5mg of Rosuvastatin, twice a week. I've been debating starting the med because I read statins don't offer much heart attack prevention after age 75. Now, I will have to look into this more if there would be some benefit to osteoporosis.

For anyone wanting more info, I googled "are statins bad for osteoporosis" and lots of articles came up. Most said low dose statin therapy would be beneficial but high dose treatment could be harmful, and that more study is needed.
https://aliyahealthcare.com/do-statins-contribute-to-osteoporosis.html
The above article says: "Although some studies suggested that low doses of statins are associated with a decreased risk for osteoporosis, high doses could potentially increase this risk. This contradicts the notion that statins, typically intended for lowering cholesterol, might serve as treatments for osteoporosis. Ultimately, further research is needed to clarify the relative efficacy and safety of statins in this context, taking into consideration dosage and patient profiles."

But it also said: "Overall, statin therapy is linked to a 48% reduction in new-onset osteoporosis risk and a significant increase in bone mineral density (BMD) by approximately 0. 030 g/cm², with no higher fracture risk noted across sensitivity analyses. A large-scale study... comparing osteoporosis diagnosis rates in statin users versus non-users. Various doses of statins were evaluated, revealing that higher doses, especially 40-60 mg of simvastatin per day, correlated with increased osteoporosis risk. Additionally, statin use in stroke patients showed decreased osteoporosis and fracture risks. Thus, low doses may provide protective benefits against osteoporosis, while high doses appear to elevate the risk of bone damage, underscoring the importance of considering dosage in treatment strategies."

Then it offered what seems to be conflicting data on fracture prevention: "While some observational studies indicated that statin users may have lower fracture risks or higher BMD, current evidence does not support a fracture prevention effect from statins. Specifically, randomized trials showed no association between statins and fracture risk...Although statin use was linked to a minor BMD increase, it did not correlate with a decrease in fracture rates. Meta-analysis of 21 studies involving over 1. 7 million participants showed statin users had a reduced risk of major osteoporotic fractures. Despite evidence suggesting statins enhance bone formation, their long-term effects on fracture risk remain uncertain. Some studies indicate a reduced risk for osteoporotic fractures in older adults taking statins. Overall, statins may increase BMD but not significantly lower fracture risk."

Here is another interesting article: https://www.ccjm.org/content/ccjom/69/4/277.full.pdf

@bluebonnet242 from what I've read, calcium is unlikely to significantly interfere with rosuvastatin absorption, though calcium citrate is generally preferred over carbonate form to minimize any potential interaction. Regarding magnesium, the main concern is with magnesium oxide which could reduce rosuvastatin absorption; other salt forms such as glycinate are fine.

I don't take calcium supplement myself, but I do take my evening magnesium glycinate alongside rosuvastatin. Rosuvastatin can be taken anytime without regard to food, thanks to its long half life. It's best taken at the same time each day.

I've been on statins for 18 months. I recently finished a two-year course of Tymlos. My bone density improved 18 percent, and my calcium blood tests were always normal. My LDL went from 135 to 70. So, no issues on either side.

@mayblin Thanks! I’m happy I don’t need to worry about spacing it out and can take at night with my magnesium glycinate and progesterone.

@daisy17 thanks for the info. Unfortunately I am on a high dose, 40mg, of rosuvastain due to extremely high LP(a) levels. I cannot find a suitable bone loss drug that will work well with my other health issues. But I will bring this up with my endo next month. I wish they had better answers available about the impact on statins on bone health.

@llander1966 Me too. I get frustrated reading about possible BMD and fracture benefits from things such as statins, Fortibone, vitamin K and others that my doctors never mention.

One article I read on statins said 4 studies showed that low dose of statins improved BMD but had no fracture benefit, while 4 other studies showed BMD improvement and fewer fractures. So obviously more studies are needed. IMO, it doesn't matter if BMD is improved if it doesn't results in fewer fractures. But it doesn't appear there are more studies in progress.

I can't help feeling that if osteoporosis primarily affected men, more effort would be given to finding drugs that could help without the terrible side effects of the drugs currently available. The drugs would probably be cheaper too.

@llander1966 My step-daughter has the same issues with LP(a). I wonder if you can take a lower dose of a statin and add ezetimibe to help make up for the lower statin dose? I don't know...just a thought that maybe you can discuss with your Endo. I also read that metaformin may help boost osteoblast activity. Another thing to consider if you also have pre-diabetes or are overweight or are a full blown diabetic. I'm not a doctor so take everything I say with a grain of salt. I've just been looking at multiple studies regarding osteoporosis and these are just a few tidbits I came across. I wish there were better solutions.