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HMG-CoA Reductase Inhibitors Increase BMD in Type 2 Diabetes Mellitus Patients¹

Department of Endocrinology and Metabolism, Ajou University School of Medicine (Y.-S.C., M.-D.L., S.-K.L., H.-M.K.), Suwon, Korea 442-721; and Division of Endocrinology, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic and Mayo Foundation (L.A.F.), Rochester, Minnesota 55905

Address correspondence and requests for reprints to: Lorraine A. Fitzpatrick, M.D., Endocrine Research Unit, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905.

Recently, it was reported that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors increased bone mineral density (BMD) in mice. We studied the effect of HMG-CoA reductase inhibitors on BMD of type 2 diabetes mellitus by a retrospective review of medical records.

Sixty-nine type 2 diabetic patients were included. The control group (n = 33) did not take HMG-CoA reductase inhibitors. The treatment group (n = 36) was administered either lovastatin, pravastatin, or simvastatin. BMD of the spine, femoral neck, femoral trochanter, and total hip were measured by dual-energy X-ray absorptiometry.

There were no significant differences between control and treatment groups in age, sex, body mass index, glycemic control, and serum insulin levels. In the control group, BMD of the spine significantly decreased (from 1.116 ± 0.165 to 1.081 ± 0.178 g/cm²) after 14 months. In the treatment group, BMD of the femoral neck significantly increased (from 0.853 ± 0.139 to 0.878 ± 0.147 g/cm²) after 15 months. In male subjects treated with HMG-CoA reductase inhibitors, there was a significant increase in BMD of the femoral neck and femoral trochanter (from 0.899 ± 0.139 to 0.934 ± 0.139 and from 0.801 ± 0.145 to 0.833 ± 0.167 g/cm², respectively), but in female subjects, only BMD of the femoral neck increased (from 0.819 ± 0.132 to 0.834 ± 0.143 g/cm²). Percentage increments of BMD of the femoral neck, femoral wards triangle, femoral trochanter, and total hip in the treatment group were significantly higher than in the control group (2.32% vs. -0.99, 1.77% vs. -1.25%, 1.40% vs. -1.21%, 0.88% vs. -1.03%, respectively). The proportion of subjects who had an increase in BMD of the spine and total hip more than two percentages was significantly larger in the treatment group than in the control group (30.6% vs. 15.2% and 30.6% vs. 9.1%, respectively). The increased increment in BMD of the treatment group was significantly greater than those in the control group after adjustment for age and body mass index (P < 0.05).

These results suggest that HMG-CoA reductase inhibitors may increase BMD of the femur in male patients with type 2 diabetes mellitus.

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