Seyyed Mostafa Arabi
1,2 
, Mahla Chambari
3, Leila Sadat Bahrami
1,4, Ali Jafari
5,6, Hossein Bahari
4, Željko Reiner
7,8, Amirhossein Sahebkar
9,10,11* 1 Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
2 Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran.
3 Department of Food Science and Nutrition, Faculty of Applied Sciences, UCSI university, 56000 Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia.
4 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
5 Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
6 Student Research Committee, Department of Nutrition, School of Health, Golestan University of Medical Sciences, Gorgan, Iran.
7 Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia.
8 Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland.
9 Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
10 Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
11 Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract
Purpose: Statin therapy is widely used for the management of dyslipidemia and the prevention of cardiovascular diseases (CVDs). However, there is a growing concern about its potential effects on bone metabolism markers and mineral density. The aim of this systematic review and meta-analysis was to investigate the effect of statin therapy on these parameters.
Methods: PubMed/MEDLINE, Scopus, and Clarivate Analytics Web of Science databases were searched from inception to August 2023, using MESH terms and keywords.
Results: After screening 2450 articles, 16 studies that met the inclusion criteria were included, of which 12 randomized controlled trials (RCTs) were used for meta-analysis. The findings showed that statin therapy significantly reduced bone-specific alkaline phosphatase (B-ALP) levels (WMD=-1.1 U/L; 95% CI -2.2 to -0.07; P=0.03; I2=0%,), and bone mineral density (BMD) at different sites (WMD=-0.06 g/cm2 ; 95% CI -0.08 to -0.04; P<0.001; I2=97.7%, P<0.001). However, this treatment did not have a significant effect on osteocalcin, serum C-terminal peptide of type I collagen (S-CTx), serum N-telopeptides of type I collagen (NTx) concentration, or overall fracture risk.
Conclusion: This systematic review and meta-analysis provide evidence that statin therapy is associated with a significant reduction in B-ALP levels and BMD at different sites of the skeleton. Further studies are needed to investigate the long-term effects of statin therapy on bone health and to identify the potential underlying mechanisms.