pioglitazone and osteoporosis

Last edited 08/2020

A matched case-control study was carried out using data from a multicentre prospective observational study of people with diabetes in managed care, to assess the odds of thiazolidinedione (TZD) exposure in patients with type 2 diabetes with and without fractures

• a total of 747 cases with fracture and 2,657 age-, sex- and BMI-matched controls who had not experienced a fracture were identified
• among women aged 50 and older, those with fractures were significantly more likely (p<0.05) to be exposed to TZDs (OR 1.71; 95% CI 1.13 to 2.58), glucocorticoids (OR 1.90; 95% CI 1.36 to 2.65), and loop diuretics (OR 1.49; 95% CI 1.08 to 2.06) and to have limited mobility (OR 1.51; 95% CI 1.20 to 1.90)
• thiazolidinediones were not significantly associated with fractures in women aged below 50, although there were only five fracture cases in TZD users in this age group
• in men, fractures were significantly associated with concurrent use of loop diuretics and TZDs (OR 3.46; 95% CI 1.06 to 11.28), exposure to glucocorticoids (OR 1.79; 95% CI 1.11 to 2.87), and insulin (OR 1.59; 95%CI 1.11 to 2.29), as well as limited mobility (OR 1.96; 95% CI 1.45 to 2.65) and lower-extremity amputation (OR 2.29; 95% CI 1.21 to 4.32)
• high TZD doses were associated with significantly greater odds of fracture for women aged 50 and older (OR 1.42; 95% CI 1.12 to 1.79) but not for men or women aged below 50 (1)

People aged over 50 using TZDs are at higher fracture risk than people with diabetes who are treated with other agents and should be considered for fracture-risk assessment, particularly in the presence of other risk factors (2)

Reference:

• Bilik D, McEwen LN, Brown MB, Bop NE, Kim C, Asao K, et al. Thiazolidinediones and fractures: evidence from translating research into action for diabetes. Journal of Clinical Endocrinology & Metabolism 2010;95(10):4560-5.
• SIGN (June 2020). Management of osteoporosis and the prevention of fragility fractures