M Ajmal, A.J. Matas, M. Kuskowski, and E.Y. Cheng
Departments of Orthopaedic Surgery, Surgery, University of Minnesota
Minneapolis VA Medical Center, Minneapolis, Minnesota USA
Introduction: The relationship between corticosteroids and osteonecrosis (ON) is well known. Limited data have suggested that statins modulate cholesterol metabolism and may protect against ON. We analyzed our, NIH supported, prospective renal transplant database to determine if statin usage reduces the incidence of corticosteroid-related osteonecrosis.
Materials and Methods: We identified 2881 renal transplantation patients who met our inclusion/exclusion criteria. There were 1752 male and 1129 female patients with mean age 43 years (range, 16 to 77). Mean follow-up was 128 months (range, 36 to 242 months). We identified 338 of 2881 patients as being on statins for over 1 year, commencing within 31 days of their transplant.
Results: Among the 338 patients on statins, 15 (4.4%) developed osteonecrosis vs. 180 of 2543 (7%) not on statins. Kaplan-Meier life table analysis of ON-free survival did not show a statistically significant relationship between statin exposure and development of ON (p=0.14, Log-Rank).
Discussion: We conclude that among our renal transplant patients, an association between statin usage and lower risk of osteonecrosis was not found, and if a reduction in incidence of ON actually exists, it is likely to be quite small. In addition, male gender and higher number of rejection episodes were independent predictive factors for ON.