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?
Answer: C. Pioglitazone increases the risk for fractures
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, durability of effectiveness, it has been associated with a decreased risk of cardiovascular events and it decreases triglycerides.
Inzucchi S, et al. Management of hyperglycemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012; 35(6):1364-1379.