Thiazolidinedione use and bone loss in older diabetic adults
Thiazolidinedione use and bone loss in older diabetic adults
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DOI：
10.1210/jc.2005-2226
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发表时间：
2006-09-01
影响因子：
5.8
通讯作者：
Cummings, Steven R.
中科院分区：
文献类型：
--
作者：
Schwartz, Ann V.;Sellmeyer, Deborah E.;Cummings, Steven R.
背景：噻唑烷二酮类 (TZD) 激活过氧化物酶体增殖物激活受体-γ 会导致小鼠骨量降低。目的：本研究的目的是确定 TZD 的使用是否与患有 2 型糖尿病的老年人骨矿物质密度 (BMD) 的变化相关。设计：我们分析了来自健康、衰老和身体成分观察研究的 4 年随访数据。设置：该研究是在一般情况下进行的患者：白人和黑人，身体健全的男性和女性，年龄在 70-79 岁之间，基线时患有自我报告的糖尿病，使用降糖药物，空腹血糖升高（>= 126 mg/dl），或 2 小时葡萄糖耐量测试升高（>= 200 mg/dl）参与了这项研究。 主要结果指标：测量全身、腰椎（源自全身）和髋部 BMD每 2 年通过双能 X 射线吸收测定法进行一次测量。结果：在 666 名糖尿病参与者中，69 名在年度就诊时报告使用 TZD，包括曲格列酮 (n = 22)、吡格列酮 (n = 30) 和/或罗格列酮 (n = 31)。使用 TZD 的患者与其他糖尿病患者相比，基线血红蛋白 A(1c) 较高，体重减轻较少，但基线 BMD 和体重相似。在针对与 TZD 使用和 BMD 相关的潜在混杂因素进行调整的重复测量模型中，每年使用 TZD 都会导致全身骨质流失量增加 [每年额外流失 -0.61%；女性糖尿病患者的 95% 置信区间 (CI) -1.02，-0.21% 每年]、腰椎（-1.23% 每年；95% CI -2.06，-0.40% 每年）和转子（-0.65% 每年；95% CI -1.18，-0.12% 每年）。结论：这些观察结果表明， TZD 可能会导致老年女性骨质流失。这些结果需要在随机试验中进行测试。
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 A(1c) 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.