Center for Health Services Research, Henry Ford Health System, 1 Ford Place, 3A Center for Health Services Research, Detroit, Michigan 48202, USA.
J Clin Endocrinol Metab. 2010 Feb;95(2):592-600. doi: 10.1210/jc.2009-1385. Epub 2010 Jan 8.
Thiazolidinedione (TZD) use has recently been associated with an increased risk of fractures.
The aim of this study was to determine the time-dependent relationship between TZD use and fracture risk.
We conducted a retrospective cohort study in a large health system in southeast Michigan.
PATIENTS who received care from the health system were included if they were at least 18 yr of age, had a diagnosis of diabetes, and had at least one prescription for an oral diabetes medication. These criteria identified 19,070 individuals (9,620 women and 9,450 men).
This study compared patients treated with TZDs to patients without TZD treatment. Cox proportional hazard models were used to assess the relationship between exposure and outcomes.
The primary outcome was the time to fracture. Secondary analyses examined the risk of fractures in subgroups defined by sex and age.
TZD use was associated with an increased risk of fracture in the cohort overall [adjusted hazard ratio (aHR), 1.35; 95% confidence interval (CI), 1.05-1.71] and in women (aHR, 1.57; 95% CI, 1.16-2.14), but not in men (aHR, 1.05; 95% CI, 0.70-1.58). Women more than 65 yr of age appeared to be at greatest risk for fracture (aHR, 1.72; 95% CI, 1.17-2.52). Among women, the increased fracture risk was not apparent until after 1 yr of TZD treatment.
TZD use was associated with an increased risk for fractures in women, particularly at ages above 65 yr. Clinicians should be aware of this association when considering TZD therapy so as to appropriately manage and counsel their patients.
噻唑烷二酮(TZD)的使用最近与骨折风险增加有关。
本研究旨在确定 TZD 使用与骨折风险之间的时依关系。
我们在密歇根州东南部的一个大型医疗系统中进行了回顾性队列研究。
如果患者年龄至少为 18 岁,有糖尿病诊断,并且至少有一份口服糖尿病药物处方,则纳入该医疗系统接受治疗的患者。这些标准确定了 19070 人(9620 名女性和 9450 名男性)。
本研究比较了接受 TZD 治疗的患者与未接受 TZD 治疗的患者。使用 Cox 比例风险模型评估暴露与结局之间的关系。
主要结局是骨折发生时间。次要分析检查了按性别和年龄定义的亚组中骨折的风险。
TZD 使用与整个队列中的骨折风险增加相关(调整后的危险比[aHR],1.35;95%置信区间[CI],1.05-1.71),且在女性中(aHR,1.57;95% CI,1.16-2.14),但在男性中并非如此(aHR,1.05;95% CI,0.70-1.58)。65 岁以上的女性似乎骨折风险最高(aHR,1.72;95% CI,1.17-2.52)。在女性中,TZD 治疗 1 年后才出现骨折风险增加。
TZD 使用与女性骨折风险增加相关,尤其是在 65 岁以上的女性中。当考虑 TZD 治疗时,临床医生应注意到这种关联,以便对其患者进行适当的管理和咨询。