The association between thiazolidinediones and hospitalisation for fracture in type 2 diabetic patients: a Taiwanese population-based nested case–control study

Hsiao, Fei‐Yuan; Mullins, C. Daniel

doi:10.1007/s00125-009-1609-z

Cited by 21 publications

(13 citation statements)

References 18 publications

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“…Increased fracture risk in women was also found in the meta-analysis of Loke et al (Fig. Other studies have also shown a significant increase in fracture risk associated with both rosiglitazone and pioglitazone treatment [159][160][161][162]. Other studies have also shown a significant increase in fracture risk associated with both rosiglitazone and pioglitazone treatment [159][160][161][162].…”

Section: Thiazolidinedione Treatment and Risk Of Fracturessupporting

confidence: 52%

Obesity, Diabetes, and Fractures

Premaor

Compston

2013

Osteoporosis

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Section: Thiazolidinedione Treatment and Risk Of Fracturessupporting

confidence: 52%

Obesity, Diabetes, and Fractures

Premaor

Compston

2013

Osteoporosis

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“…Recent modifications to the method render it less sensitive to assumption but the modified method remains sensitive to the assumption that exposure is not event dependent–in the case of hip fracture and TZDs this assumption cannot be made; TZD exposure is less likely once fracture has occurred [23]. One case–control study with 18,000 fracture cases found effects on total and hip fracture in women and no overall or hip effect in men but the levels of TZD exposure in men were low (only 1,971 exposed men were included) [24]. A recent report also found evidence of a cumulative effect of TZDs on total fracture but not hip fracture [25].…”

Section: Discussionmentioning

confidence: 99%

Hospitalised hip fracture risk with rosiglitazone and pioglitazone use compared with other glucose-lowering drugs

et al. 2012

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Aims/hypothesisCurrent drug labels for thiazolidinediones (TZDs) warn of increased fractures, predominantly for distal fractures in women. We examined whether exposure to TZDs affects hip fracture in women and men and compared the risk to that found with other drugs used in diabetes.MethodsUsing a nationwide database of prescriptions, hospital admissions and deaths in those with type 2 diabetes in Scotland we calculated TZD exposure among 206,672 individuals. Discrete-time failure analysis was used to model the effect of cumulative drug exposure on hip fracture during 1999–2008.ResultsThere were 176 hip fractures among 37,479 exposed individuals. Hip fracture risk increased with cumulative exposure to TZD: OR per year of exposure 1.18 (95% CI 1.09, 1.28; p = 3 × 10−5), adjusted for age, sex and calendar month. Hip fracture increased with cumulative exposure in both men (OR 1.20; 95% CI 1.03, 1.41) and women (OR 1.18; 95% CI 1.07, 1.29) and risks were similar for pioglitazone (OR 1.18) and rosiglitazone (OR 1.16). The association was similar when adjusted for exposure to other drugs for diabetes and for other potential confounders. There was no association of hip fracture with cumulative exposure to sulfonylureas, metformin or insulin in this analysis. The 90-day mortality associated with hip fractures was similar in ever-users of TZD (15%) and in never-users (13%).Conclusions/interpretationHip fracture is a severe adverse effect with TZDs, affecting both sexes; labels should be changed to warn of this. The excess mortality is at least as much as expected from the reported association of pioglitazone with bladder cancer.

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“…We defined a fracturespecific hospitalization as a hospital admis sion with a discharge diagnosis of fracture (ICD-9-CM codes 800829). 24 Patients with incident dementia were defined as those who had at least 3 outpatient or inpa tient claim records of a diagnosis of dementia (290.xx, 294.1x, 331.0, 331.2). 25 The first date of any of these diagnosis codes was considered the date of onset.…”

Section: Adverse Outcomesmentioning

confidence: 99%

Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

et al. 2017

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PURPOSE No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this populationbased cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults.METHODS From Taiwan's Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index -Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up. For all 3 scales, a higher score indicates greater anticholinergic burden. We used generalized estimating equations to examine the association between anticholinergic burden (ARS and ACB: grouped from 0 to ≥4; DBI-Ach: grouped as 0, 0-0.5, and 0.5-1) and adverse outcomes, and stratified individuals by age-group (aged 65-74, 75-84, and ≥85 years). RESULTSCompared with the ARS and DBI-Ach, the ACB showed the strongest, most consistent dose-response relationships with risks of all 4 adverse outcomes, particularly in people aged 65 to 84 years. For example, among those 65 to 74 years old, going from an ACB score of 1 to a score of 4 or greater, individuals' adjusted odds ratio increased from 1.41 to 2.25 for emergency department visits; from 1.32 to 1.92 for all-cause hospitalizations; from 1.10 to 1.71 for fracturespecific hospitalizations; and from 3.13 to 10.01 for incident dementia.CONCLUSIONS Compared with the 2 other scales studied, the ACB shows good dose-response relationships between anticholinergic burden and a variety of adverse outcomes in older adults. For primary care and geriatrics clinicians, the ACB may be a helpful tool for identifying high-risk populations for interventions. Ann Fam Med 2017;15:561-569. https://doi.org/10.1370/afm.2131. INTRODUCTIONM edications with anticholinergic properties are used for a variety of diseases and constitute 30% to 50% of all medications com monly prescribed to older adults. 1 The agingrelated decline of acetylcholine production may increase the vulnerability of older adults to anticholinergic adverse effects, 2,3 such as blurred vision, urinary retention, tachycardia, drowsiness, and cognitive impairments. 4 The blurred vision and dizziness caused by exposure to anticholinergic agents may further result in falls and associated adverse events. 57 The cognitive impairment associated with exposure to these medications may lead to chronic cogni tive deficits such as dementia. 4,8 The cumulative effect of multiple anti cholinergic agents, the socalled anticholinergic burden, has been used as an indicator for suboptimal prescribing in older adults. 9 In recent years, several scoring systems have been developed to quantify anticholinergic burden, such as the Anticholinergic Risk Scale (ARS), 10 562These scales differ considerably in how they were developed, in their method of measuring antich...

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The association between thiazolidinediones and hospitalisation for fracture in type 2 diabetic patients: a Taiwanese population-based nested case–control study

Cited by 21 publications

References 18 publications

Obesity, Diabetes, and Fractures

Obesity, Diabetes, and Fractures

Hospitalised hip fracture risk with rosiglitazone and pioglitazone use compared with other glucose-lowering drugs

Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

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