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Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-2226
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The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 9 3349-3354
Copyright © 2006 by The Endocrine Society

Thiazolidinedione Use and Bone Loss in Older Diabetic Adults

Ann V. Schwartz, Deborah E. Sellmeyer, Eric Vittinghoff, Lisa Palermo, Beata Lecka-Czernik, Kenneth R. Feingold, Elsa S. Strotmeyer, Helaine E. Resnick, Laura Carbone, Brock A. Beamer, Seok Won Park, Nancy E. Lane, Tamara B. Harris, Steven R. Cummings for the Health, Aging and Body Composition (Health ABC) Study

Department of Epidemiology and Biostatistics (A.V.S., E.V., L.P.) and Division of Endocrinology (D.E.S., K.R.F.), Department of Medicine, University of California, San Francisco, San Francisco, California 94107-1762; Department of Geriatrics (B.L.-C.), Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202; Department of Epidemiology (E.S.S., S.W.P.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Epidemiology (H.E.R.), MedStar Research Institute, Hyattsville, Maryland 20785; Division of Rheumatology (L.C.), Department of Medicine, University of Tennessee, Memphis, Tennessee 38163; Department of Medicine (B.A.B.), Johns Hopkins University, Baltimore, Maryland 21205; Department of Medicine (S.W.P.), Pochon CHA University, Seoul 135-081 Korea; Department of Medicine (N.E.L.), University of California, Davis, Sacramento, California 95616; Laboratory of Epidemiology, Demography, and Biometry (T.B.H.), National Institute on Aging, Bethesda, Maryland 20892; and Research Institute (S.R.C.), California Pacific Medical Center, San Francisco, California 94120

Address all correspondence and requests for reprints to: Ann V. Schwartz, Ph.D., Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry Street, Lobby 4, Suite 5700, San Francisco, California 94107-1762. E-mail: aschwartz{at}psg.ucsf.edu.

Context: Activation of peroxisome proliferator-activated receptor-{gamma} by thiazolidinediones (TZDs) results in lower bone mass in mice.

Objective: The objective of the study was to determine whether TZD use is associated with changes in bone mineral density (BMD) in older adults with type 2 diabetes.

Design: We analyzed 4-yr follow-up data from the Health, Aging, and Body Composition observational study.

Setting: The study was conducted in a general community.

Patients: White and black, physically able men and women, aged 70–79 yr at baseline with diabetes defined by self-report, use of hypoglycemic medication, elevated fasting glucose (≥126 mg/dl), or elevated 2-h glucose tolerance test (≥200 mg/dl) participated in the study.

Main Outcome Measures: Whole-body, lumbar spine (derived from whole body), and hip BMD were measured by dual-energy x-ray absorptiometry at 2-yr intervals.

Results: Of 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 hemoglobin A1c 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% confidence interval (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.

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




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