BACKGROUND: The purpose of this study was to examine the association of statin use and musculoskeletal conditions within the population of U.S. Air Force active duty aviators.METHODS: The study was a retrospective cohort analysis of aviators between 2004–2014 as identified from personnel data. Based on pharmacy data, participants were divided into two groups: statin users (received a statin for at least 90 d) and nonusers (never received a statin throughout the study period). Using participants’ baseline characteristics, a propensity score was generated and used to match statin users to nonusers in a 1:6 ratio. Conditional logistic regression was used to determine the odds ratio for a musculoskeletal condition.RESULTS: A total of 19,330 participants met study criteria (131 statin users and 19,199 nonusers). Of these, 112 statin users were matched to 672 nonusers. Among matched pairs, statin users were not at significantly increased risk (odds ratio: 1.239; 95% confidence interval: 0.768, 1.999) for musculoskeletal conditions. Likewise, there was no observed significant association between specific musculoskeletal disease diagnosis groups and statin use.CONCLUSIONS: In this aviator population, there was not an increased overall likelihood of musculoskeletal conditions for statin users relative to propensity score-matched nonusers. A well-designed prospective cohort analysis or clinical trial is needed to ascertain possible adverse effects of statins on performance in the aviation environment.Tvaryanas AP, Wagner JH, Maupin GM. Statins and musculoskeletal conditions in U.S. Air Force active duty aviators. Aerosp Med Hum Perform. 2018; 89(5):421–427.