To the Editor: Dr van Staa and colleagues1 concluded that "use of statins . . . was not associated
with a reduction in risk of fracture." This conclusion is contrary to the
results of our study2 as well as others.3,4 Our results, like those of van
Staa et al, were derived from the General Practice Research Database (GPRD).
However, the study by van Staa et al encompassed 683 practices originally
considered to have data of satisfactory quality; by contrast, the Boston Collaborative
Drug Surveillance Program conducts ongoing internal (unpublished) validation
studies to identify practices that provide unsatisfactory data. As a result,
several practices were excluded and our recent study encompassed only 340
practices. Van Staa et al also failed to exclude patients at high risk for
fracture, for instance patients with osteoporosis, osteomalacia, cancer, alcoholism,
and those receiving bisphosphonates. We excluded such patients since it is
well recognized that including persons who are already at high risk for an
outcome will dilute the effect of a drug on the outcome.5
These methodological differences resulted in van Staa et al identifying 81 880
fracture cases, while we identified only 3940.
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