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Thiazolidinedione (TZD) Use and Bone Loss in Older Diabetic Adults

Activation of peroxisome proliferator-activated receptor (PPAR)-gamma by thiazolidinediones (TZDs) results in lower bone mass. The object of the study was to determine if TZD use is associated with changes in bone mineral density (BMD) in older adults with type 2 diabetes. Design: A 4-year follow-up data from the Health, Aging, and Body Composition observational study, was analyzed. The setting was in the general community. Patients: White and black, physically able, men and women, age 70-79 yr at baseline with diabetes, defined by self-report, use of hypoglycemic medication, elevated fasting glucose (>/= 126 mg/dl), or elevated 2-hr glucose tolerance test (>/= 200 mg/dl).

The main outcome measures were: Whole body, lumbar spine (derived from whole body) and hip BMD were measured by dual energy x-ray absorptiometry at 2-year intervals.

The results showed that out of the 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 HbA1c 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% 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.

These observational results suggest that TZDs may cause bone loss in older women. These results need to be tested in a randomized trial.

J Clin Endocrinol Metab. 2006 Apr 11; [Epub ahead of print]

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