Use of thiazolidinediones and risk of osteoporotic fracture: disease or drugs?
PURPOSE: Clinical and observational studies suggest that use of thiazolidinediones (TZDs) is associated with an increased fracture risk. In addition, type 2 diabetes mellitus (T2DM) is a risk factor for osteoporotic fracture. Our aim was to estimate fracture risks in TZD users and users of other ant...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
| Language: | English |
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2012
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| _version_ | 1797079306154803200 |
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| author | Bazelier, M Gallagher, A van Staa, T Cooper, C Leufkens, H Vestergaard, P de Vries, F |
| author_facet | Bazelier, M Gallagher, A van Staa, T Cooper, C Leufkens, H Vestergaard, P de Vries, F |
| author_sort | Bazelier, M |
| collection | OXFORD |
| description | PURPOSE: Clinical and observational studies suggest that use of thiazolidinediones (TZDs) is associated with an increased fracture risk. In addition, type 2 diabetes mellitus (T2DM) is a risk factor for osteoporotic fracture. Our aim was to estimate fracture risks in TZD users and users of other antidiabetic drugs, classified according to proxies of disease severity. METHODS: We conducted a population-based cohort study utilizing the Dutch PHARMO database (1998-2008). PHARMO links pharmacy-dispensing data to the National Hospital Registry. Oral antidiabetic users (n = 123,452) were matched 1:4 by year of birth and sex to non-users. Cox proportional hazards models were used to estimate hazard ratios (HRs) of fracture in TZD users. We created a proxy indicator for disease severity. The first stage was defined as current use of either a biguanide or a sulfonylureum, the second stage as current use of a biguanide and a sulfonylureum at the same time, the third stage was assigned to patients using TZDs and the fourth stage to patients using insulin. RESULTS: The risk of osteoporotic fracture was increased 1.5-fold (HR 1.49, 95%CI 1.28-1.73) in patients who currently used TZDs (stage 3), and for patients using insulin (stage 4), the risk was increased 1.2-fold (HR 1.24, 1.14-1.36), as compared with controls. In the first and second stages, risks were lower: HR 1.11 (1.06-1.17) for stage 1 and HR 1.03 (0.96-1.11) for stage 2. CONCLUSIONS: When observational studies assess risk of fracture in patients with TZDs, the severity of T2DM should be taken into account. |
| first_indexed | 2024-03-07T00:43:56Z |
| format | Journal article |
| id | oxford-uuid:83fcd9fa-99c7-4547-8828-3a1c61674bf7 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T00:43:56Z |
| publishDate | 2012 |
| record_format | dspace |
| spelling | oxford-uuid:83fcd9fa-99c7-4547-8828-3a1c61674bf72022-03-26T21:48:05ZUse of thiazolidinediones and risk of osteoporotic fracture: disease or drugs?Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:83fcd9fa-99c7-4547-8828-3a1c61674bf7EnglishSymplectic Elements at Oxford2012Bazelier, MGallagher, Avan Staa, TCooper, CLeufkens, HVestergaard, Pde Vries, FPURPOSE: Clinical and observational studies suggest that use of thiazolidinediones (TZDs) is associated with an increased fracture risk. In addition, type 2 diabetes mellitus (T2DM) is a risk factor for osteoporotic fracture. Our aim was to estimate fracture risks in TZD users and users of other antidiabetic drugs, classified according to proxies of disease severity. METHODS: We conducted a population-based cohort study utilizing the Dutch PHARMO database (1998-2008). PHARMO links pharmacy-dispensing data to the National Hospital Registry. Oral antidiabetic users (n = 123,452) were matched 1:4 by year of birth and sex to non-users. Cox proportional hazards models were used to estimate hazard ratios (HRs) of fracture in TZD users. We created a proxy indicator for disease severity. The first stage was defined as current use of either a biguanide or a sulfonylureum, the second stage as current use of a biguanide and a sulfonylureum at the same time, the third stage was assigned to patients using TZDs and the fourth stage to patients using insulin. RESULTS: The risk of osteoporotic fracture was increased 1.5-fold (HR 1.49, 95%CI 1.28-1.73) in patients who currently used TZDs (stage 3), and for patients using insulin (stage 4), the risk was increased 1.2-fold (HR 1.24, 1.14-1.36), as compared with controls. In the first and second stages, risks were lower: HR 1.11 (1.06-1.17) for stage 1 and HR 1.03 (0.96-1.11) for stage 2. CONCLUSIONS: When observational studies assess risk of fracture in patients with TZDs, the severity of T2DM should be taken into account. |
| spellingShingle | Bazelier, M Gallagher, A van Staa, T Cooper, C Leufkens, H Vestergaard, P de Vries, F Use of thiazolidinediones and risk of osteoporotic fracture: disease or drugs? |
| title | Use of thiazolidinediones and risk of osteoporotic fracture: disease or drugs? |
| title_full | Use of thiazolidinediones and risk of osteoporotic fracture: disease or drugs? |
| title_fullStr | Use of thiazolidinediones and risk of osteoporotic fracture: disease or drugs? |
| title_full_unstemmed | Use of thiazolidinediones and risk of osteoporotic fracture: disease or drugs? |
| title_short | Use of thiazolidinediones and risk of osteoporotic fracture: disease or drugs? |
| title_sort | use of thiazolidinediones and risk of osteoporotic fracture disease or drugs |
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