Trends in statin prescription among osteoporosis patients: A retrospective cohort study using UK primary care data

Statin prescribing patterns in osteoporosis patients remain uncharacterized despite cardiovascular disease being a leading cause of mortality in this population. This study examined temporal trends and demographic variations in statin prescription rates among osteoporosis patients in the UK. This research is a retrospective cohort study utilizing the IQVIA Medical Research Data (IMRD) spanning 2005-2019. Patients' diagnosis of osteoporosis and corresponding statin prescription data were extracted. Prevalence and incidence of statin prescription were calculated, followed by age-stratified and gender-stratified trends analysis using joinpoint regression to calculate the average percent change (APC), annual average percent change (AAPC), and identify significant temporal shifts. Among 157,483 identified osteoporosis patients, statin prescribing trends demonstrated significant reductions in both prescription prevalence (AAPC: -1.03%, p = 0.005) and incidence rate (AAPC:-1.82%, p < 0.001). Gender-based analysis revealed higher prescription rates and more pronounced declines in male patients (prevalence AAPC:2.7% vs female -0.8%), resulting in prescription rate convergence by study end. Age stratified findings showed the 70-79 years age group maintained the highest initial prevalence but experienced the steepest declines. A notable breakpoint occurred in 2018 within the 50-59 age cohort, which may be a result of stricter ACC/AHA cholesterol guidelines requiring enhanced risk-based criteria for primary and secondary prevention. The prescription peaks in 2006 and 2014 likely coincided with NICE guideline modifications. Despite these guideline expansions encouraging broader statin use, sensitivity analysis of cumulative defined daily dose revealed persistently high discontinuation rates in osteoporosis patients. These patterns indicate substantial gaps in cardiovascular protection for this vulnerable population. Declining statin prescription trends among osteoporosis patients, particularly among elderly males, appear to reflect an evolution in clinical practices toward risk-benefit assessment. These findings highlight the need for treatment guideline advancement that addresses both appropriate statin initiation and strategies to improve long-term adherence in patients with multimorbidity.