Effects of TZD Use and Discontinuation on Fracture Rates in ACCORD Bone Study
Ann V Schwartz1, Haiying Chen1, Walter T Ambrosius1
1University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425.
Thiazolidinedione (TZD) use increases fracture risk in women with type 2 diabetes. Discontinuing TZDs in women reduces this fracture risk, while men show no association.
Area of Science:
- Endocrinology and Metabolism
- Diabetes Mellitus Research
- Bone Health and Osteoporosis
Background:
- Thiazolidinediones (TZDs) are linked to increased fracture risk in women.
- The impact of discontinuing TZD therapy on fracture incidence remains unclear.
Purpose of the Study:
- To examine the association between thiazolidinedione (TZD) use, discontinuation, and non-spine fractures in women and men.
- To clarify the fracture risk profile associated with TZD therapy in a large cohort.
Main Methods:
- Longitudinal observational cohort study utilizing data from the ACCORD trial bone ancillary study.
- Time-varying proportional hazards models were used to assess non-spine fracture risk based on TZD use and discontinuation.
- 6865 participants with type 2 diabetes were analyzed for fracture occurrence over a mean follow-up of 4.8 years.
Main Results:
- Women using TZDs for 1-2 years (HR=2.32) or >2 years (HR=2.01) had higher non-spine fracture rates compared to non-users.
- Women who discontinued TZDs showed reduced fracture rates: 1-2 years post-discontinuation (HR=0.57) and >2 years post-discontinuation (HR=0.42).
- No significant association between TZD use/discontinuation and non-spine fractures was observed in men.
Conclusions:
- Thiazolidinedione (TZD) use is associated with an elevated risk of non-spine fractures in women with type 2 diabetes.
- Discontinuation of TZD therapy in women leads to an attenuation of fracture risk.
- The findings suggest a sex-specific effect of TZDs on fracture risk, with no observed impact in men.
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