Increased fracture risk in patients treated with thiazolidinediones: the role of abnormal bone turnover

Abstract

Evaluation of: Zinman B, Haffner SM, Herman WH et al. Effect of rosiglitazone, metformin, and glyburide on bone biomarkers in patients with Type 2 diabetes. J. Clin. Endocrinol. Metab. 95(1), 134–142 (2010).

Until recently, patients with Type 2 diabetes were thought to be relatively protected against osteoporosis by their high BMI. However, recent epidemiological data suggest that fracture risk is increased in diabetic patients. Additionally, use of thiazolidinedione antidiabetic medications (rosiglitazone and pioglitazone) was unexpectedly found to be associated with an increased risk of fractures. The paper under evaluation in this article examines changes in biochemical markers of bone turnover in subjects within the clinical trial that first raised the issue of fractures. The main finding was a significant increase in bone resorption with rosiglitazone. This conclusion conflicts with other studies examining the effects of thiozolidinediones on bone and, by itself, is unlikely to fully explain the increased fracture risk seen with these drugs.

Keywords::

• bone
• diabetes
• fracture
• obesity
• osteoporosis
• pioglitazone
• rosiglitazone
• thiazolidinedione

Financial & competing interests disclosure

Mark Cooper is supported by an unrestricted Clinician Scientist Fellowship from GlaxoSmithKline, the manufacturer of rosiglitazone. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.