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Effects of pioglitazone on renal calcium excretion

Anne Zanchi1, Antoinette Pechère-Bertschi, Michel Burnier

  • 1Service of Nephrology, Department of Medicine, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. Anne.Zanchi@chuv.ch

The Journal of Clinical Endocrinology and Metabolism
|July 15, 2011
PubMed
Abstract

Insights

Pioglitazone increases urinary calcium excretion and lowers parathyroid hormone (PTH) levels, independent of sodium intake. This suggests pioglitazone may inhibit kidney calcium reabsorption, potentially contributing to fracture risk.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Glitazones are associated with increased fracture risk.
  • Glitazones negatively impact bone metabolism and renal sodium reabsorption.
  • Potential regulation of renal calcium excretion by glitazones was hypothesized.

Purpose of the Study:

  • To investigate the effects of pioglitazone on renal calcium and phosphate excretion.
  • To assess the impact of pioglitazone on parathyroid hormone (PTH) levels.
  • To determine if sodium intake influences pioglitazone's effects on calcium and phosphate excretion.

Main Methods:

  • Double-blind, randomized, placebo-controlled, four-way crossover study.
  • 16 participants (8 with type 2 diabetes, 8 with essential hypertension) received pioglitazone (45 mg/d) or placebo for 6 weeks.
  • Evaluated renal calcium and phosphate excretion and PTH levels under varying sodium intakes.

Main Results:

  • Pioglitazone significantly increased urinary calcium excretion by 45% and fractional calcium excretion.
  • Pioglitazone reduced alkaline phosphatase and PTH levels.
  • No significant effect on plasma calcium, phosphate, or urinary phosphate excretion was observed.
  • The calciuric effect was independent of sodium intake and glomerular filtration rate.

Conclusions:

  • Pioglitazone inhibits tubular calcium reabsorption in the kidneys.
  • Pioglitazone reduces PTH levels and increases urinary calcium excretion.
  • These renal effects may contribute to the increased fracture risk associated with glitazone therapy.

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