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Thiazolidinediones May Up Fracture Risk in Older Women

Concurrent thiazolidinediones, loop diuretics appear to increase risk for men

THURSDAY, July 29 (HealthDay News) -- In type 2 diabetes patients, thiazolidinedione (TZD) exposure is associated with an increased risk of fracture in women age 50 and older -- especially in higher doses -- and in men who are concurrently exposed to loop diuretics, according to research published online July 14 in the Journal of Clinical Endocrinology and Metabolism.

Dori Bilik, of the University of Michigan in Ann Arbor, and colleagues conducted a prospective observational study of type 2 diabetes patients with and without fractures to determine the odds of TZD use in both. They identified 786 fracture patients, and each was matched by health plan, age, gender, body mass index, and race/ethnicity with up to four controls.

The researchers found that, for women 50 years of age and older with fractures, there were significantly increased adjusted odds of exposure to TZDs (odds ratio [OR], 1.71), glucocorticoids, and loop diuretics, as well as of having self-reported limited mobility. Fracture risk was also associated with high TZD dose in this group (OR, 1.42). Younger women with fractures did not have increased odds of TZD exposure, but the odds for other exposures were similar to those for women age 50 and older. Men with fractures had significantly increased odds of concurrent exposure to TZDs and loop diuretics (OR, 3.46). Exposure to glucocorticoids and insulin, limited mobility, and lower-extremity amputation were also linked to fractures in men.

"In conclusion, we confirmed the increased risk of fractures for older women treated with TZDs and identified increased risk of fracture in men who are concurrently taking loop diuretics and TZDs. Risk was associated with higher TZD dose, but no difference between rosiglitazone and pioglitazone was apparent, suggesting a class effect of TZDs on fracture risk. Future studies, particularly long-term, prospective randomized clinical trials will be needed to conclusively demonstrate small to moderate harm," the authors write.

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