Volume: 3, 2024
3rd International PhD Student’s Conference at the University of Life Sciences in Lublin, Poland:
ENVIRONMENT – PLANT – ANIMAL – PRODUCT
Abstract number: H006
DOI: https://doi.org/10.24326/ICDSUPL3.H006
Published online: 24 April 2024
ICDSUPL, 3, H006 (2024)
Can statins, commonly used to lower cholesterol, affect the musculoskeletal system?
Piotr Kiszowara1*, Ewelina Cholewińska2, Wojciech Dworzański1, Katarzyna Ognik2
1 Department of Cardiology, Dr. Tytus Chałubiński Specialist Hospital in Radom, Lekarska 4, 26-610 Radom, Poland
2 Department of Biochemistry and Toxicology, Faculty of Animal Sciences and Bioeconomy, University of Life Sciences in Lublin, Akademicka 13, 20-950 Lublin, Poland
* Corresponding author: kiszowara.piotr@gmail.com
Abstract
Statins are a commonly prescribed class of drugs used to lower cholesterol levels by inhibiting the mevalonate pathway due to blocking HMG-CoA reductase [Morse et al. 2018]. Therefore, they reduce the risk of developing atherosclerosis and its acute complications, such as acute myocardial infarction and ischemic stroke [Granat et al. 2024]. In addition to their LDL-Cholesterol-lowering effect, statins also have a pleiotropic effect, i.e., an additional effect other than their main mechanism of action [Morse et al. 2018]. Available literature proves that the pleiotropic effect of statins includes affecting the musculoskeletal system through the ability to modulate the differentiation and function of bone cells and exerting a direct influence on osteosynthetic factors, in particular osteogenic differentiation observed both in vitro and in vivo studies [Morse et al. 2018, Chamani et al. 2021]. The locomotor system consists of a passive part (bones, their connections – joints, ligaments, tendons) and an active part (skeletal muscles). These systems cooperate to enable movement [Kerkman et al. 2018]. Statins affect bone metabolism by increasing the expression of many mediators such as bone morphogenetic protein-2 (BMP-2), glucocorticoids, transforming growth factor beta (TGF-β), alkaline phosphatase (ALP), collagen type I and collagenase-1, including thereby supporting bone formation and improving bone mineral density by modulating the differentiation of osteoblasts and osteoclasts [Chamani et al. 2021]. However, the latest literature reports indicate that such a positive effect of statins on the musculoskeletal system can only be achieved when they are used in low doses [Lautner et al. 2019]. It was established that taking statins at a level of 10 milligrams a day or less was associated with a 60% reduced risk of osteoporosis, depending on the type of statin administered [Lautner et al. 2019]. At the same time, it has been shown that increasing the doses of statins used in patients above 10 mg/day may have negative side effects in the form of an increased risk of osteoporosis [Lautner et al. 2019]. Research conducted by Lin et al. [2018] also showed that the negative effects of statins on the skeletal system are particularly pronounced in Asian populations. However, the basic pathophysiological mechanisms underlying the relationship between the use of higher doses of statins and their negative impact on the skeletal system are currently unknown and require further research. Interestingly, the use of statins may additionally influence the development of tendinopathy, i.e., tendon inflammation. Eliasson et al. [2019] report that the reason for the development of tendinopathy in people using statins is due to the fact that the statin induces excessive release of matrix metalloproteinase (MMP) in the tendon tissue, which results in a weakening of the tendinous matrix, as a result of which the mechanical strength of the tendon (stiffness and maximal strength) decreases. Research by Kwak et al. [2023] confirmed that the use of statins significantly increases the risk of developing tendinopathy regardless of the type of statin used.
To sum up, people using statins and at high risk of osteoporosis (e.g., postmenopausal women or elderly people) or tendon diseases should be especially careful and monitor the condition of their bones and tendons.
Keywords: statins, tendinopathy, bone
How to cite
P. Kiszowara, E. Cholewińska, W. Dworzański, K. Ognik, 2024. Can statins, commonly used to lower cholesterol, affect the musculoskeletal system?. In: 3rd International PhD Student’s Conference at the University of Life Sciences in Lublin, Poland: Environment – Plant – Animal – Product. https://doi.org/10.24326/ICDSUPL3.H006