February 12, 2010. Women with type 2 diabetes who take commonly prescribed medications to treat insulin resistance may be at a higher risk for developing bone fractures.
According to medical reserachers, after taking a thiazolidinedione (TZD) for one year, women are 50 percent more likely to have a bone fracture than patients not taking TZDs. And those at the greatest risk for fractures from TZD use are women older than 65.
Older women are already at a higher risk of osteoporosis and osteoporosis-related fractures, which might explain why they appeared to be the most affected by TZDs, medical experts explain. The study – one of the largest groups to examine the longitudinal relationship between TZD use and fractures – appears in this month’s issue of The Journal of Clinical Endocrinology & Metabolism.
TZDs such as pioglitazone and rosiglitazone help keep blood glucose levels on target by decreasing insulin resistance and making body tissues more sensitive to insulin’s effects. TZDs also cut down on the amount of glucose made by the liver in patients with type 2 diabetes.
But in recent years, TZDs have been linked to bone loss and increasing fracture risk. Complicating matters, type 2 diabetes and insulin use are also associated with an increased risk for fractures.
The group studied nearly 10,000 women. During the study period, 4,511 patients had at least one prescription fill for a TZD. The researchers used electronically maintained medical claims data to identify non-traumatic bone fractures. The increased risk in women appeared after approximately one year of TZD use.
The location of the fractures in this group also was unique. Typically, osteoporosis-related fractures involve the vertebra and hip. This study, however, found TZD use in women to be associated with fractures of the upper extremity and distal lower extremity. Similar findings were observed in treated women older than 65, who were shown to have a 70 percent increased risk for developing fractures. Men, regardless of age, were not at an increased risk for fractures.
“Although two recent studies suggest that men may also be at increased risk for fractures after TZD exposure, we did not observe this association for men, despite having nearly equal numbers of men and women in our study,” says study co-author Zeina A. Habib, M.D.
“Fractures are just one of several problems associated with aging and a frequent cause of needing long-term care by seniors,” explains Jesse Slome, executive director of the American Association for Long-Term Care Insurance. The educational organization notes that currently some 10 million Americans need long-term care services.
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