ADA 2010

The use of Thiazolidinediones in the current clinical context was reviewed in a symposium on the opening day of the 2010 ADA conference in Orlando.

Data suggesting that markers of bone formation are reduced in patients taking Rosiglitazone whilst resorption is unaltered were shown to attendees (Grey et al. JCEM 2007; 92: 1305-10).

More recent data supporting the possibility that this may result in bone thinning with a 2% reduction in BMD after 3 months of therapy with Rosiglitazone in diabetes were also presented (JCEM 2010; 95: 134-142).

Data from PCOS patients were then presented and suggest that a similar phenomenon is observed when this cohort is treated with Pioglitazone, raising the probability that there is a class effect for adverse metabolic activity in bone for the TZD’s.

It was pointed out to delegates that this theoretical risk is supported by data from the ADOPT study where increased fracture risk was observed in TZD treated patients. The RECORD study confirms this finding with the observation of increased long bone fractures, especially in women.

In concluding the presentation of TZD bone data, delegates were reminded that the skeletal risk conferred by TZD therapy was related to duration of therapy.

Data are incomplete, and it is not yet clear whether TZD use in men confers the same fracture risk as occurs in women. However the risk to bone health of long term therapy TZD's should be explained when initiaing this therapy for people with diabetes.