Glycemic Control with Thiazolidinedione Is Associated with Fracture of T2DM Patients

Abstract

ObjectiveDiabetes is a common diseases and a major problem worldwide. Diabetic osteopathy might be elevated in diabetic patients and is usually caused by bone fracture. Several diabetes medications, such as thiazolidinediones (TZDs), could lead to increased risks of fracture.MethodsWe used the nationwide database to identified 32466 patients who had developed type 2 diabetes from 2000 to 2010 as the diabetic cohort and, from that group, we selected 3427 diabetic patients who had developed bone fracture to survey the possible risk factors, includng commonly used diabetes medication.ResultsWe found that TZDs might present increased risks for fracture in patients who used it for an extended period (7 to 730 days before the index date), especially in female patients younger than 64 years old, for whom the risk was elevated from a 1.74- to a 2.58-fold odds ratio.ConclusionsWe recommend that clinics follow up with non-osteoporotic female patients younger than 64 years old who are using TZDs, to avoid the associated risks of fracture.

Diabetes pharmacotherapy and effects on the musculoskeletal system

“…271 However, these skeletal alterations appeared at very high plasma concentrations, outside of the concentration range reached with the human therapeutic dose. 272 Two other studies using repaglinide/troglitazone, specifically 273 or nateglinide/troglitazone, specifically 270 as combination therapy demonstrated better reduction in HbA1c in the combination groups compared with mono-therapy for both glinides. No bone fractures were reported as adverse events in these studies; however, treatment duration for these trials was ≤22 weeks.…”

“…By retrospective analysis of T2D patients in the Taiwanese National Health Insurance Claims Database from 2000 to 2010, an examination of bone fractures by medication category demonstrated that repaglinide (but not nateglinide), particularly when used in combination with TZDs, was shown to increase the risk of bone fracture, particularly in older female T2D patients between 65 and 74 years of age (aOR 1.83; 95% CI 1.19‐2.79; adjusted for ESRD, stroke, osteoporosis) . Two other studies using repaglinide/troglitazone, specifically or nateglinide/troglitazone, specifically as combination therapy demonstrated better reduction in HbA1c in the combination groups compared with mono‐therapy for both glinides.…”

Effect of repaglinid on ovariectomy induced bone loss in rats: comparison with 17beta-estradiol

“…Similar results were also observed in the study of Vierte et al (19) The effects of RPG on long bone development seen in all studies only occurred at excessively high plasma concentrations that will not be reached at human therapeutic doses. However, a recent study have showed that using RPG can increase the risk of fracture, through various mechanisms, in type 2 diabetic patients (between 65 t0 74 years of age) (9).…”

“…RPG has a large utility as a therapeutic agent in the treatment of diabetic patients (8). Recent research shows that RPG may play a role for fracture for older diabetic patients (9). RPG was a kind of non-sulfonylureas that was prescribed for unsteady postprandial glucose regulation in order to prevent hypoglycemia (8).…”

Influence of diabetes on tissue healing in orthopaedic injuries

“…According to the review by Gilbert and Pratley, thiazolidinediones increase the rate of bone loss and the risk of fractures in the population of patients with diabetes . Chen et al found that TZDs caused an increased risk of fractures particularly in women under 64 years of age. It seems that thiazolidinediones impair the function of osteoblasts and activate osteoclastogenesis.…”