Healthcare

Thiazolidinediones (TZDs) is class of medication used in the diabetes mellitus type 2 treatment.
Instead the adverse effect known currently such as increased risk of coronary heart disease and heart attack, edema, water retention, and including the incidence risk of hepatitis and liver failure from older type of Thiazolidinediones that make this medications should be prescribed carefully, recent study just found that Thiazolidinediones also may increase the risk of fracture in postmenopausal diabetic women and some in man.

By using Translatin Research into Action for Diabetes (TRIAD) data, a comprehensive observational study for diabetes care management, the study authors, Dori Bilik, MBA, from the University of Michigan in Arnn Arbor, and colleagues, write in their report that published in July 14 in the Journal of Clinical Endocrinology & Metabolism, “…TZDs, including rosiglitazone and pioglitazone, have been associated with increased risk of fractures in post-menopausal women. Both in-vivo and in-vitro results have suggested that TZD activation of peroxisome proliferator-activated receptor-gamma may reduce bone formation. Previous studies were limited to patients recently diagnosed with type 2 diabetes, excluded patients using after other anti-hyperglycemic medications and corticosteroids, or did not account for race/ethnicity in the case-control matching criteria.”

In the study, the researchers performed a matched case-control study to assess medication exposures and other factors associated with fractures in patients with diabetes type 2. Health plan (HP) administrative data identified 786 patients with fractures, and up to 4 control subjects without any fractures diagnoses were matched to each case patient, based on HP date of birth within 5 years, race or ethnicity, sex, and body mass index within 5 kg/m2.

Odds of exposure to potential risk factors for fracture, such as medications, self-reported limited mobility, and lower-extremity amputations were determined with use of conditional logistic regression for pre-menopausal and post-menopausal women and for men.

Overall, from the study results, there is significant statistically among women at least 50 years old with fracture from exposing of TZDs, glucocorticoids, loop diuretics, and self-reported limited mobility.
In men, fractures were associated with exposure to born loop diuretics and TZDs, glucocorticoids and insulin, and limited mobility, as well as lower-extremity amputation.

The study author write, “post-menopausal women taking TZDs and the subset of men taking both loop diuretics and TZDs were at increased risk for fractures. In post-menopausal women, risk was associated with higher TZD dose. No difference between rosiglitazone and pioglitazone was apparent.”

Despite several limitations in the study such as reliance on pharmacy prescriptions, inclusion of a small number of women younger than 50 years, failure to inspect x-ray data to confirm fracture diagnoses, and reliance on administrative data sources, the authors added, “future studies, particularly long-term, prospective randomized clinical trials will be needed to conclusively demonstrate small to moderate harm.”