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Thiazolidinediones increase odds of fracture among women with type 2 diabetes, meta-analysis reveals

Thursday, December 18 2008 | Comments
Evidence Grade 2 What's This?
The likelihood of fractures among women, but not men, with type 2 diabetes is doubled with long-term use of thiazolidinediones, according to a new meta-analysis that focused on rosiglitazone maleate and pioglitazone hydrochloride.

Researchers conducted a literature review to identify randomized controlled trials (RCTs) and controlled observational studies that compared the risk of fracture among patients with type 2 diabetes who were using a thiazolidinedione with those not receiving such therapy.

The investigators also examined studies that compared changes in bone mineral density (BMD) in patients using thiazolidinediones versus those who were not.

The review yielded 10 RCTs representing 13,715 individuals and 2 observational studies representing 31,679 individuals.

Among the RCTs, both rosiglitazone and pioglitazone were associated with a 45% increase in the odds of fractures overall (OR, 1.45; 95% CI, 1.18-1.79; P<.001). Five of these trials in particular reported fracture risk by sex, and the results revealed a more than 2-fold increase in the odds of fracture among women (OR, 2.23; 95% CI, 1.65-3.01; P<.001), although this outcome was not observed among men (OR, 1.00; 95% CI, 0.73-1.39; P=.98).

As with the RCTs, the 2 observational studies demonstrated a significant association between thiazolidinedione exposure and fractures among women but not men.

In terms of BMD changes, the studies analyzed showed a statistically significant decline in both lumbar spine and hip BMD among women who used thiazolidinediones.

The investigators suggested that the benefits of thiazolidinediones should be balanced against their long-term effects on bone and the cardiovascular system.

"Clinicians should reconsider the use of thiazolidinediones in women with type 2 diabetes," they concluded.

The study by Loke YK, et al. was published online by the Canadian Medical Association Journal as an early release Dec. 10.

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