Senior Women at High Risk of Bone Fractures After
Taking Diabetes Drugs Avandia or Actos
TZDs have previously been linked to bone loss,
increasing fracture risk; type 2 diabetes and insulin also increase risk
for fractures
Thiazolidinediones
help insulin work better at the cell site. In essence, they increase the
cell's sensitivity (responsiveness) to insulin. MedlinePlus
Feb. 10, 2010 The results of new research seems
to make it abundantly clear that as previous research has found older
women senior citizens over 65 significantly increase their risk of
bone fractures by taking a thiazolidine (TZD) drug. These drugs,
primarily Avandia (rosiglitazone) and Actos (pioglitazone), are commonly
prescribed to treat insulin resistance in type 2 diabetes.
A Henry Ford Hospital study finds that after taking
a TZD for one year, women are 50 percent more likely to have a bone
fracture than patients not taking TZDs. And those at the greatest risk
for fractures from TZD use are women older than 65.
Thiazolidinediones medications (including rosiglitazone
(Avandia)
produced a significantly increased risk of heart attack, congestive
heart failure and death
"Older women are already at a higher risk of
osteoporosis and osteoporosis-related fractures, which might explain why
they appeared to be the most affected by TZDs," says study senior author
L. Keoki Williams, M.D., MPH, Center for Health Services Research and
Department of Internal Medicine at Henry Ford Hospital.
Thiazolidinediones (THIGH-ah-ZO-li-deen-DYE-owns)
help make cells more sensitive to insulin. The insulin can then move
glucose from blood into cells for energy.
The study one of the largest groups to examine
the longitudinal relationship between TZD use and fractures appears in
this month's issue of The Journal of Clinical Endocrinology &
Metabolism.
TZDs such as pioglitazone and rosiglitazone help
keep blood glucose levels on target by decreasing insulin resistance and
making body tissues more sensitive to insulin's effects. TZDs also cut
down on the amount of glucose made by the liver in patients with type 2
diabetes.
But in recent years, TZDs have been linked to bone
loss and increasing fracture risk. Complicating matters, type 2 diabetes
and insulin use are also associated with an increased risk for
fractures.
One TZD, troglitazone (Rezulin), was withdrawn from
the market due to an increased incidence of drug-induced hepatitis.
To determine the relationship between TZD use and
fracture risk in patients with type 2 diabetes, Dr. Williams and his
colleagues conducted a retrospective study from Jan. 2, 2000 to May 31,
2007 of 19,070 Henry Ford patients. Among the study group, 9,620 were
women and 9,450 were men.
During the study period, 4,511 patients had at
least one prescription fill for a TZD. The researchers used
electronically maintained medical claims data to identify non-traumatic
bone fractures. The increased risk in women appeared after approximately
one year of TZD use.
The location of the fractures in this group also
was unique. Typically, osteoporosis-related fractures involve the
vertebra and hip. This study, however, found TZD use in women to be
associated with fractures of the upper extremity and distal lower
extremity.
Similar findings were observed in treated women
older than 65, who were shown to have a 70 percent increased risk for
developing fractures. Men, regardless of age, were not at an increased
risk for fractures.
"Although two recent studies suggest that men may
also be at increased risk for fractures after TZD exposure, we did not
observe this association for men, despite having nearly equal numbers of
men and women in our study," says study co-author Zeina A. Habib, M.D.
Another study published in 2006 in the same journal
found by observational results that TZDs maycause bone loss
in older women. This was a follow-up on a study with mice that found
bone loss in older mice given TZDs.
African-American race-ethnicity was protective for
fractures when compared with other race-ethnic groups, which were
predominately Caucasian.
"Fractures are just one of a growing number of
problems associated with these medications. Henry Ford and other
researchers have previously found that this class of medications also
can increase risk of congestive heart failure hospitalization," says Dr.
Williams.
Dr. Williams notes that there are other medication
options available to treat insulin resistance in patients with type 2
diabetes.
"TZDs may put some patients at increased risk for
other health issues, and I encourage patients to talk with their
physician about other suitable options," says Dr. Williams. "If the
physician feels the patient should be placed on a TZD, routine screening
for bone loss and prophylactic therapy to prevent bone loss and
fractures may also be needed."
Editors Notes:
Reference: "Thiazolidinedione Use and the
Longitudinal Risk of Fractures in Patients with Type 2 Diabetes
Mellitus." The Journal of Clinical Endocrinology & Metabolism.
Funding: Henry Ford Hospital, and grants from the
National Heart, Lung and Blood Institute, and the National Institute of
Diabetes and Digestive and Kidney Diseases, National Institutes of
Health.
Learning About Diabetes Pills>
Different kinds of diabetes pills work in different ways to control
blood sugar. If one pill is not working well enough on its own, your
doctor or nurse may combine it with a second kind of pill. This chart
shows the different kinds of diabetes pills and how they work.
More News on Diabetes from SeniorJournal.com
Archives
About Rosiglitazone,
marketed as Avandia
Combination products: Avandaryl (containing
rosiglitazone and glimepiride) and Avandamet (containing rosiglitazone
and metformin)
Why is this medication prescribed?
Rosiglitazone is used along with a diet and
exercise program and sometimes with one or more other medications to
treat type 2 diabetes (condition in which the body does not use insulin
normally and, therefore, cannot control the amount of sugar in the
blood). Rosiglitazone is in a class of medications called
thiazolidinediones. It works by increasing the body's sensitivity to
insulin, a natural substance that helps control blood sugar levels.
Rosiglitazone is not used to treat type 1 diabetes (condition in which
the body does not produce insulin and, therefore, cannot control the
amount of sugar in the blood) or diabetic ketoacidosis (a serious
condition that may occur if high blood sugar is not treated).
How should this medicine be used?
Rosiglitazone comes as a tablet to take by mouth.
It is usually taken once or twice daily with or without meals. Take
rosiglitazone at about the same time(s) every day. Follow the directions
on your prescription label carefully, and ask your doctor or pharmacist
to explain any part you do not understand. Take rosiglitazone exactly as
directed. Do not take more or less of it or take it more often than
prescribed by your doctor.
Your doctor may increase your dose of rosiglitazone
after 8-12 weeks, based on your body's response to the medication.
Rosiglitazone helps control type 2 diabetes but
does not cure it. It may take 2 weeks for your blood sugar to decrease,
and 2-3 months or longer for you to feel the full benefit of
rosiglitazone. Continue to take rosiglitazone even if you feel well. Do
not stop taking rosiglitazone without talking to your doctor.
Other uses for this medicine
This medication may be prescribed for other uses;
ask your doctor or pharmacist for more information.
Warning:
Rosiglitazone and other similar medications
for diabetes may cause or worsen congestive heart failure
(condition in which the heart is unable to pump enough blood to
the other parts of the body). Some studies have shown that
people who take rosiglitazone and insulin are more likely to
have a heart attack or to die of heart problems than people who
take insulin alone. Before you start to take rosiglitazone, tell
your doctor if you have or have ever had congestive heart
failure, especially if your heart failure is so severe that you
must limit your activity and are only comfortable when you are
at rest or you must remain in a chair or bed. Also tell your
doctor if you were born with a heart defect, and if you have or
have ever had swelling of the arms, hands, feet, ankles, or
lower legs; heart disease, high blood pressure; coronary artery
disease (narrowing of the blood vessels that lead to the heart);
a heart attack; an irregular heartbeat; or high cholesterol or
fats in the blood. Your doctor may tell you not to take
rosiglitazone or may monitor you carefully during your
treatment.
If you develop congestive heart failure or
other heart problems, you may experience certain symptoms. Tell
your doctor immediately if you have any of the following
symptoms, especially when you first start taking rosiglitazone
or after your dose is increased: large weight gain in a short
period of time; shortness of breath;swelling of the arms, hands,
feet, ankles, or lower legs; chest pain.swelling or pain in the
stomach; waking up short of breath during the night; needing to
sleep with extra pillows in order to breathe while lying down;
frequent dry cough; or increased tiredness.
Talk to your doctor about the risks of
taking rosiglitazone.
