Efficacy of Statins in Postmenopausal Osteoporosis: A Systematic Review and Meta-Analysis

Osteoporosis is a prevalent metabolic bone disease in postmenopausal women, characterized by reduced bone mineral density (BMD) and increased fracture risk. Statins, commonly prescribed for cardiovascular conditions, have been suggested to possess bone-modulating effects via the mevalonate pathway. This systematic review and meta-analysis evaluated the efficacy of statins in improving BMD and reducing fracture risk in postmenopausal osteoporosis. A comprehensive literature search identified six randomized controlled trials involving 1,032 participants. Primary outcomes included changes in BMD at the lumbar spine, femoral neck, and forearm, along with bone turnover markers and fracture incidence. Pooled analyses showed no significant improvement in lumbar spine BMD (mean difference (MD): 13.72%; 95% CI: -19.31 to 46.74; p = 0.42; I² = 100%) or femoral neck BMD (MD: -0.18%; 95% CI: -0.46 to 0.10; p = 0.20; I² = 99%). A statistically significant 1.1% increase in forearm BMD was observed at 52 weeks (p = 0.01), though this effect was based on a single study and lacked generalizability. Bone turnover marker findings were inconsistent, and none of the studies demonstrated significant reductions in fracture risk. The quality of evidence was rated moderate to low due to high heterogeneity and methodological limitations. Overall, statins appear to have limited and site-specific effects on BMD, with insufficient evidence to support their use as a primary therapy for osteoporosis. However, their adjunctive role may be considered in select patients with concomitant cardiovascular disease. Further research is needed to determine long-term benefits, fracture prevention potential, and cost-effectiveness in this population.