Thiazolidinedione Use and the Longitudinal Risk of Fractures in Patients with Type 2 Diabetes Mellitus

被引:116
作者
Habib, Zeina A. [2 ]
Havstad, Suzanne L. [3 ]
Wells, Karen [3 ]
Divine, George [3 ]
Pladevall, Manel [1 ]
Williams, L. Keoki [1 ,2 ,3 ]
机构
[1] Henry Ford Hlth Syst, Ctr Hlth Serv Res, Detroit, MI 48202 USA
[2] Henry Ford Hlth Syst, Dept Internal Med, Detroit, MI 48202 USA
[3] Henry Ford Hlth Syst, Dept Biostat & Res Epidemiol, Detroit, MI 48202 USA
基金
美国国家卫生研究院;
关键词
OSTEOPOROSIS-RELATED FRACTURES; ANTIEPILEPTIC DRUG-USE; BONE-MINERAL DENSITY; PPAR-GAMMA; ROSIGLITAZONE; WOMEN; HIP; RATES; MEN;
D O I
10.1210/jc.2009-1385
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Thiazolidinedione (TZD) use has recently been associated with an increased risk of fractures. Objective: The aim of this study was to determine the time-dependent relationship between TZD use and fracture risk. Design: We conducted a retrospective cohort study in a large health system in southeast Michigan. Patients: Patients who received care from the health system were included if they were at least 18 yr of age, had a diagnosis of diabetes, and had at least one prescription for an oral diabetes medication. These criteria identified 19,070 individuals ( 9,620 women and 9,450 men). Intervention: This study compared patients treated with TZDs to patients without TZD treatment. Cox proportional hazard models were used to assess the relationship between exposure and outcomes. Main Outcome Measures: The primary outcome was the time to fracture. Secondary analyses examined the risk of fractures in subgroups defined by sex and age. Results: TZD use was associated with an increased risk of fracture in the cohort overall [adjusted hazard ratio (aHR), 1.35; 95% confidence interval (CI), 1.05-1.71] and in women (aHR, 1.57; 95% CI, 1.16-2.14), but not in men (aHR, 1.05; 95% CI, 0.70-1.58). Women more than 65 yr of age appeared to be at greatest risk for fracture (aHR, 1.72; 95% CI, 1.17-2.52). Among women, the increased fracture risk was not apparent until after 1 yr of TZD treatment. Conclusions: TZD use was associated with an increased risk for fractures in women, particularly at ages above 65 yr. Clinicians should be aware of this association when considering TZD therapy so as to appropriately manage and counsel their patients. (J Clin Endocrinol Metab 95: 592-600, 2010)
引用
收藏
页码:592 / 600
页数:9
相关论文
共 46 条
[1]   PPARγ insufficiency enhances osteogenesis through osteoblast formation from bone marrow progenitors [J].
Akune, T ;
Ohba, S ;
Kamekura, S ;
Yamaguchi, M ;
Chung, UI ;
Kubota, N ;
Terauchi, Y ;
Harada, Y ;
Azuma, Y ;
Nakamura, K ;
Kadowaki, T ;
Kawaguchi, H .
JOURNAL OF CLINICAL INVESTIGATION, 2004, 113 (06) :846-855
[2]  
[Anonymous], 2000, JAMA, V283, P2228
[3]   A COMPUTER-ASSISTED PHOTOGRAMMETRIC ANALYSIS OF SOFT-TISSUE CHANGES AFTER ORTHODONTIC TREATMENT .1. METHODOLOGY AND RELIABILITY [J].
BISHARA, SE ;
CUMMINS, DM ;
JORGENSEN, GJ ;
JAKOBSEN, JR .
AMERICAN JOURNAL OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS, 1995, 107 (06) :633-639
[4]   Risk of fracture in women with type 2 diabetes: The Women's Health Initiative Observational Study [J].
Bonds, Denise E. ;
Larson, Joseph C. ;
Schwartz, Ann V. ;
Strotmeyer, Elsa S. ;
Robbins, John ;
Rodriguez, Beatriz L. ;
Johnson, Karen C. ;
Margolis, Karen L. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2006, 91 (09) :3404-3410
[5]  
Burge R, 2007, J BONE MINER RES, V22, P465, DOI [10.1359/jbmr.061113, 10.1359/JBMR.061113]
[6]  
Casellini Carolina M, 2007, Endocr Pract, V13, P550
[7]   ADAPTING A CLINICAL COMORBIDITY INDEX FOR USE WITH ICD-9-CM ADMINISTRATIVE DATABASES [J].
DEYO, RA ;
CHERKIN, DC ;
CIOL, MA .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1992, 45 (06) :613-619
[8]   Safety and Tolerability of Pioglitazone in High-Risk Patients with Type 2 Diabetes An Overview of Data from PROactive [J].
Dormandy, John ;
Bhattacharya, Mondira ;
de Bruyn, Anne-Ruth van Troostenburg .
DRUG SAFETY, 2009, 32 (03) :187-202
[9]   Thiazolidinediones and Fractures in Men and Women [J].
Dormuth, Colin R. ;
Carney, Greg ;
Carleton, Bruce ;
Bassett, Ken ;
Wright, Jarnes M. .
ARCHIVES OF INTERNAL MEDICINE, 2009, 169 (15) :1395-1402
[10]   The Risk of Fractures Associated with Thiazolidinediones: A Self-controlled Case-Series Study [J].
Douglas, Ian J. ;
Evans, Stephen J. ;
Pocock, Stuart ;
Smeeth, Liam .
PLOS MEDICINE, 2009, 6 (09)