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Pioglitazone Changes

A 62-year-old Asian-American female arrives at your office for a new patient appointment. Her current medications are metformin, pioglitazone, enalapril, lovastatin, alendronate, calcium supplements and vitamin D. Her A1C is on target at 6.9%, however you decide to replace her pioglitazone with a different antihyperglycemic medication. Why would you make this decision?

Correct

Correct Answer: C. Pioglitazone increases the risk for fractures

Educational Critique: Increased risk of bone fractures is a recognized side effect of piogliatazone (thiazolidinediones) and therefore would not be the best choice for this post-menopausal patient. For this particular patient, her ethnic background and age also place her at increased risk for osteoporosis and low bone density. Piogliatozone advantages are: no risk of hypoglycemia as a side effect, it has durability of effectiveness, it has been associated with a decreased risk of cardiovascular events and it decreases triglycerides.

Pharmacotherapy. 2010 Jul;30(7):716-27. doi: 10.1592/phco.30.7.716.

Incorrect