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Thiazolidinedione use and bone loss in older diabetic adults

Ann V Schwartz1, Deborah E Sellmeyer, Eric Vittinghoff

  • 1Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry Street, Lobby 4, Suite 5700, San Francisco, California 94107-1762, USA. aschwartz@psg.ucsf.edu

The Journal of Clinical Endocrinology and Metabolism
|April 13, 2006
PubMed
Abstract

Insights

Thiazolidinedione (TZD) use in older women with type 2 diabetes may lead to increased bone loss. Further randomized trials are needed to confirm these findings and assess the impact on bone mineral density.

Area of Science:

  • Endocrinology
  • Gerontology
  • Metabolic Diseases

Background:

  • Thiazolidinediones (TZDs) activate peroxisome proliferator-activated receptor-gamma.
  • TZD activation is linked to reduced bone mass in murine models.
  • The impact of TZDs on bone mineral density (BMD) in humans is not fully understood.

Purpose of the Study:

  • To investigate the association between TZD use and BMD changes in older adults with type 2 diabetes.
  • To determine if TZD treatment influences bone loss over a four-year period.

Main Methods:

  • Analysis of 4-year follow-up data from the Health, Aging, and Body Composition study.
  • Inclusion of community-dwelling, physically able men and women aged 70-79 with type 2 diabetes.
  • Measurement of whole-body, lumbar spine, and hip BMD using dual-energy x-ray absorptiometry at 2-year intervals.

Main Results:

  • Sixty-nine of 666 diabetic participants reported TZD use.
  • TZD users had higher baseline hemoglobin A1c and less weight loss but similar baseline BMD.
  • Each year of TZD use was associated with greater bone loss in women at the whole body, lumbar spine, and trochanter, but not in men.

Conclusions:

  • Observational data suggest TZDs may contribute to bone loss in older women with type 2 diabetes.
  • The findings highlight a potential risk of TZD therapy on skeletal health in this population.
  • Randomized controlled trials are recommended to validate these findings.

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