Abstract
References
- Green A, Hede SM, Patterson CC, et al. Type 1 diabetes in. 2017: global estimates of incident and prevalent cases in children and adults. Diabetologia. 2021;64(12):2741-2750.
- Xu G, Liu B, Sun Y, et al. Prevalence of diagnosed type 1 and type 2 diabetes among US adults in. 2016 and. 2017: population based study. BMJ (Clinical research ed). 2018;362:k1497.
- Merlotti D, Gennari L, Dotta F, et al. Mechanisms of impaired bone strength in type 1 and 2 diabetes. Nutr Metab Cardiovasc Dis. 2010;20(9):683-690.
- Karjalainen J, Knip M, Hyoty H, et al. Relationship between serum insulin autoantibodies, islet cell antibodies and Coxsackie-B4 and mumps virus-specific antibodies at the clinical manifestation of type 1 (insulin-dependent) diabetes. Diabetologia. 1988;31 (3):146-152.
- Brown SA, Sharpless JL. Osteoporosis: an under-appreciated complication of diabetes. Clinical Diabetes. 2004;22 (1):10-20.
- Collino M, Aragno M, Castiglia S, et al. Pioglitazone improves lipid and insulin levels in overweight rats on a high cholesterol and fructose diet by decreasing hepatic inflammation. Br J Pharmacol. 2010;160(8):1892-1902.
- Igarashi M, Hirata A, Yamaguchi H, et al. Pioglitazone reduces atherogenic outcomes in type 2 diabetic patients. J Atheroscler Thromb. 2008;15(1):34-40.
- Richter B, Bandeira-Echtler E, Bergerhoff K, et al. Pioglitazone for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006;2006(4):CD006060.
- Stunes AK, Westbroek I, Gustafsson BI, et al. The peroxisome proliferator-activated receptor (PPAR) alpha agonist fenofibrate maintains bone mass, while the PPAR gamma agonist pioglitazone exaggerates bone loss, in ovariectomized rats. BMC Endocr Disord. 2011;11:11.
- Lecka-Czernik B. Bone loss in diabetes:use of antidiabetic thiazolidinediones and secondary osteoporosis. Curr Osteoporos Rep. 2010;8(4):178-184.
- Takano M, Otsuka F, Matsumoto Y, et al. Peroxisome proliferator-activated receptor activity is involved in the osteoblastic differentiation regulated by bone morphogenetic proteins and tumor necrosis factor-alpha. Mol Cell Endocrinol. 2012;348(1):224-232.
- Epstein M, Bakris G. Newer approaches to antihypertensive therapy. Use of fixed-dose combination therapy. Arch Intern Med. 1996;156(17):1969-1978.
- Meymeh RH, Wooltorton E. Diabetes drug pioglitazone (Actos): risk of fracture. CMAJ. 2007;177(7):723-724.
- Kanazawa I, Yamaguchi T, Yano S, et al. Baseline atherosclerosis parameter could assess the risk of bone loss during pioglitazone treatment in type 2 diabetes mellitus. Osteoporos Int. 2010;21(12):2013-2018.
- Schwartz AV, Sellmeyer DE, Vittinghoff E, et al. Thiazolidinedione use and bone loss in older diabetic adults. J Clin Endocrinol Metab. 2006;91(9):3349-3354.
- Sottile V, Seuwen K, Kneissel M. Enhanced marrow adipogenesis and bone resorption in estrogen-deprived rats treated with the PPARgamma agonist BRL49653 (rosiglitazone). Calcif Tissue Int. 2004;75(4):329-337.
- Janghorbani M, Van Dam RM, Willett WC, et al. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166(5):495-505.
- Yamamoto M, Yamaguchi T, Yamauchi M, et al. Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications. J Bone Miner Res. 2009;24(4):702-709.
- Huang S, Kaw M, Harris MT, et al. Decreased osteoclastogenesis and high bone mass in mice with impaired insulin clearance due to liver-specific inactivation to CEACAM1. Bone. 2010;46(4):1138-1145.
- Krakauer JC, McKenna MJ, Buderer NF, et al. Bone loss and bone turnover in diabetes. Diabetes. 1995;44(7):775-782.
The effect of long-term use of pioglitazone on bone mineral density in patients with diabetes mellitus
Abstract
Aims: This study aimed to explore the incidence of osteoporosis in patients with diabetes mellitus (DM) who have been on a long-term pioglitazone regimen, and to ascertain the link between pioglitazone usage and the onset of osteoporosis.
Methods: We enrolled patients prospectively and conducted a comparative analysis between two groups of DM patients: those who had been using pioglitazone for a period exceeding two years, and those with no history of pioglitazone use. Bone Mineral Density (BMD) was assessed using dual energy X-ray absorptiometry (DEXA).
Results: There were no significant differences in age, gender, disease duration, fasting plasma glucose levels, and HbA1c levels between pioglitazone users and non-users. However, a significant variation was found in the BMD measurements. Patients on pioglitazone had an L1-L4 vertebra BMD T-score of -1.3, compared to -0.9 in non-users (p<0.05), signifying a substantial divergence in BMD between both cohorts. Furthermore, it was observed that patients with a disease duration of less than 10 years had higher BMD T-scores compared to those with disease durations exceeding 10 years, suggesting a decrease in BMD with increased disease longevity. Moreover, a higher BMD was observed in patients aged less than 50 years in comparison to those aged over 60 years.
Conclusion: Despite the clinical preference for pioglitazone in the management of DM and insulin resistance, our findings suggest that it may affect bone metabolism adversely in the long run. Hence, careful monitoring is advised during extended periods of pioglitazone use. To investigate the incidence of osteoporosis in patients with DM who use pioglitazone for a long time and to determine the relationship between pioglitazone and the cause of this osteoporosis.
References
- Green A, Hede SM, Patterson CC, et al. Type 1 diabetes in. 2017: global estimates of incident and prevalent cases in children and adults. Diabetologia. 2021;64(12):2741-2750.
- Xu G, Liu B, Sun Y, et al. Prevalence of diagnosed type 1 and type 2 diabetes among US adults in. 2016 and. 2017: population based study. BMJ (Clinical research ed). 2018;362:k1497.
- Merlotti D, Gennari L, Dotta F, et al. Mechanisms of impaired bone strength in type 1 and 2 diabetes. Nutr Metab Cardiovasc Dis. 2010;20(9):683-690.
- Karjalainen J, Knip M, Hyoty H, et al. Relationship between serum insulin autoantibodies, islet cell antibodies and Coxsackie-B4 and mumps virus-specific antibodies at the clinical manifestation of type 1 (insulin-dependent) diabetes. Diabetologia. 1988;31 (3):146-152.
- Brown SA, Sharpless JL. Osteoporosis: an under-appreciated complication of diabetes. Clinical Diabetes. 2004;22 (1):10-20.
- Collino M, Aragno M, Castiglia S, et al. Pioglitazone improves lipid and insulin levels in overweight rats on a high cholesterol and fructose diet by decreasing hepatic inflammation. Br J Pharmacol. 2010;160(8):1892-1902.
- Igarashi M, Hirata A, Yamaguchi H, et al. Pioglitazone reduces atherogenic outcomes in type 2 diabetic patients. J Atheroscler Thromb. 2008;15(1):34-40.
- Richter B, Bandeira-Echtler E, Bergerhoff K, et al. Pioglitazone for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006;2006(4):CD006060.
- Stunes AK, Westbroek I, Gustafsson BI, et al. The peroxisome proliferator-activated receptor (PPAR) alpha agonist fenofibrate maintains bone mass, while the PPAR gamma agonist pioglitazone exaggerates bone loss, in ovariectomized rats. BMC Endocr Disord. 2011;11:11.
- Lecka-Czernik B. Bone loss in diabetes:use of antidiabetic thiazolidinediones and secondary osteoporosis. Curr Osteoporos Rep. 2010;8(4):178-184.
- Takano M, Otsuka F, Matsumoto Y, et al. Peroxisome proliferator-activated receptor activity is involved in the osteoblastic differentiation regulated by bone morphogenetic proteins and tumor necrosis factor-alpha. Mol Cell Endocrinol. 2012;348(1):224-232.
- Epstein M, Bakris G. Newer approaches to antihypertensive therapy. Use of fixed-dose combination therapy. Arch Intern Med. 1996;156(17):1969-1978.
- Meymeh RH, Wooltorton E. Diabetes drug pioglitazone (Actos): risk of fracture. CMAJ. 2007;177(7):723-724.
- Kanazawa I, Yamaguchi T, Yano S, et al. Baseline atherosclerosis parameter could assess the risk of bone loss during pioglitazone treatment in type 2 diabetes mellitus. Osteoporos Int. 2010;21(12):2013-2018.
- Schwartz AV, Sellmeyer DE, Vittinghoff E, et al. Thiazolidinedione use and bone loss in older diabetic adults. J Clin Endocrinol Metab. 2006;91(9):3349-3354.
- Sottile V, Seuwen K, Kneissel M. Enhanced marrow adipogenesis and bone resorption in estrogen-deprived rats treated with the PPARgamma agonist BRL49653 (rosiglitazone). Calcif Tissue Int. 2004;75(4):329-337.
- Janghorbani M, Van Dam RM, Willett WC, et al. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166(5):495-505.
- Yamamoto M, Yamaguchi T, Yamauchi M, et al. Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications. J Bone Miner Res. 2009;24(4):702-709.
- Huang S, Kaw M, Harris MT, et al. Decreased osteoclastogenesis and high bone mass in mice with impaired insulin clearance due to liver-specific inactivation to CEACAM1. Bone. 2010;46(4):1138-1145.
- Krakauer JC, McKenna MJ, Buderer NF, et al. Bone loss and bone turnover in diabetes. Diabetes. 1995;44(7):775-782.
Details
| Primary Language | English |
|---|---|
| Subjects | Endocrinology |
| Journal Section | Research Articles |
| Authors | |
| Early Pub Date | July 26, 2023 |
| Publication Date | July 28, 2023 |
| Published in Issue | Year 2023 Volume: 5 Issue: 3 |
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https://doi.org/10.38053/acmj.1338092
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