Thiazolidinedione use and bone loss in older diabetic adults.
BACKGROUND
Activation of peroxisome proliferator-activated receptor-gamma by thiazolidinediones (TZDs) results in lower bone mass in mice.


OBJECTIVE
The objective of the study was to determine whether TZD use is associated with changes in bone mineral density (BMD) in older adults with type 2 diabetes.


METHODS
We analyzed 4-yr follow-up data from the Health, Aging, and Body Composition observational study.


METHODS
The study was conducted in a general community.


METHODS
White and black, physically able men and women, aged 70-79 yr at baseline with diabetes defined by self-report, use of hypoglycemic medication, elevated fasting glucose (>/=126 mg/dl), or elevated 2-h glucose tolerance test (>/=200 mg/dl) participated in the study.


METHODS
Whole-body, lumbar spine (derived from whole body), and hip BMD were measured by dual-energy x-ray absorptiometry at 2-yr intervals.


RESULTS
Of 666 diabetic participants, 69 reported TZD use at an annual visit, including troglitazone (n = 22), pioglitazone (n = 30), and/or rosiglitazone (n = 31). Those with TZD use had higher baseline hemoglobin A(1c) and less weight loss over 4 yr but similar baseline BMD and weight than others with diabetes. In repeated-measures models adjusted for potential confounders associated with TZD use and BMD, each year of TZD use was associated with greater bone loss at the whole body [additional loss of -0.61% per year; 95% confidence interval (CI) -1.02, -0.21% per year], lumbar spine (-1.23% per year; 95% CI -2.06, -0.40% per year), and trochanter (-0.65% per year; 95% CI -1.18, -0.12% per year) in women, but not men, with diabetes.


CONCLUSIONS
These observational results suggest that TZDs may cause bone loss in older women. These results need to be tested in a randomized trial.
Schwartz
Ann V
AV
Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry Street, Lobby 4, Suite 5700, San Francisco, California 94107-1762, USA. aschwartz@psg.ucsf.edu
Sellmeyer
Deborah E
DE
Vittinghoff
Eric
E
Palermo
Lisa
L
Lecka-Czernik
Beata
B
Feingold
Kenneth R
KR
Strotmeyer
Elsa S
ES
Resnick
Helaine E
HE
Carbone
Laura
L
Beamer
Brock A
BA
Park
Seok Won
SW
Lane
Nancy E
NE
Harris
Tamara B
TB
Cummings
Steven R
SR
D015502:Absorptiometry, Photon; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight; D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced; D011446:Prospective Studies; D045162:Thiazolidinediones / Q000009:adverse effects* / Q000627:therapeutic use*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; C089946:2,4-thiazolidinedione