Kanazawa I, Yamaguchi T, Yano S, Yamamoto M, Yamauchi M, Kurioka S, Sugimoto T
Department of Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
Osteoporos Int. 2010 Dec;21(12):2013-8. doi: 10.1007/s00198-009-1161-1. Epub 2010 Feb 4.
We found that serum osteocalcin, femoral bone mineral density (F-BMD), and 1/3R-BMD were decreased during pioglitazone treatment in patients with type 2 diabetes. Moreover, baseline atherosclerosis parameter, serum insulin-like growth factor-I (IGF-I), and urinary N-terminal cross-linked telopeptide of type I collagen (uNTX) values were associated with changes in bone mineral density (BMD). Therefore, these parameters could assess the risk of BMD reduction in patients treated with pioglitazone.
The aim of this study was to investigate the effects of pioglitazone or metformin on bone mass and atherosclerosis in patients with type 2 diabetes.
A total of 55 Japanese patients were enrolled in this 1-year open-label study and randomized to either pioglitazone (n = 22, 15-30 mg/day) or metformin (n = 23, 500-750 mg/day) groups. BMD at the lumbar spine, femoral neck (F), and one third of the radius (1/3R), bone markers, and atherosclerosis parameters were measured.
In the pioglitazone group, serum osteocalcin significantly decreased at 6 months (p < 0.05), although it almost recovered to baseline level at 12 months. F-BMD significantly decreased at 6 months (p < 0.05), and 1/3R-BMD significantly decreased at 6 and 12 months (p < 0.05), while bone markers or BMD at any site were not changed in the metformin group. Although atherosclerosis parameters were not changed in the pioglitazone group, intima-media thickness (IMT)-mean significantly increased at 6 months (p < 0.05) and plaque score significantly increased at 6 and 12 months (p < 0.01) in the metformin group. In the pioglitazone group, %changes in F-BMD were significantly and negatively correlated with baseline IMT-Max, IMT-mean, and plaque scores (r = -0.61, p < 0.01; r = -0.71, p < 0.01; and r = -0.68, p < 0.01, respectively), and %changes in 1/3R-BMD were significantly and negatively correlated with baseline uNTX and IMT-Max (r = -0.57, p < 0.01 and r = -0.48, p < 0.05, respectively) and positively with IGF-I (r = 0.45, p < 0.05).
Baseline IMT, uNTX, and IGF-I could assess the risk of BMD reduction in diabetic patients treated with pioglitazone.
我们发现，在2型糖尿病患者的吡格列酮治疗期间，血清骨钙素、股骨骨矿物质密度（F-BMD）和1/3桡骨骨矿物质密度（1/3R-BMD）均有所下降。此外，基线动脉粥样硬化参数、血清胰岛素样生长因子-I（IGF-I）和I型胶原的尿N端交联肽（uNTX）值与骨矿物质密度（BMD）的变化相关。因此，这些参数可用于评估接受吡格列酮治疗患者的BMD降低风险。
本研究旨在探讨吡格列酮或二甲双胍对2型糖尿病患者骨量和动脉粥样硬化的影响。
本项为期1年的开放标签研究共纳入55例日本患者，随机分为吡格列酮组（n = 22，15 - 30毫克/天）或二甲双胍组（n = 23，500 - 750毫克/天）。测量腰椎、股骨颈（F）和桡骨1/3处（1/3R）的骨密度、骨标志物和动脉粥样硬化参数。
在吡格列酮组中，血清骨钙素在6个月时显著下降（p < 0.05），尽管在12个月时几乎恢复到基线水平。F-BMD在6个月时显著下降（p < 0.05），1/3R-BMD在6个月和12个月时显著下降（p < 0.05），而二甲双胍组任何部位的骨标志物或骨密度均未改变。尽管吡格列酮组的动脉粥样硬化参数未改变，但二甲双胍组的内膜中层厚度（IMT）平均值在6个月时显著增加（p < 0.05），斑块评分在6个月和12个月时显著增加（p < 0.01）。在吡格列酮组中，F-BMD的变化百分比与基线IMT-Max、IMT平均值和斑块评分显著负相关（r = -0.61，p < 0.01；r = -0.71，p < 0.01；r = -0.68，p < 0.01），1/3R-BMD的变化百分比与基线uNTX和IMT-Max显著负相关（分别为r = -0.57，p < 0.01和r = -0.48，p < 0.05），与IGF-I呈正相关（r = 0.45，p < 0.05）。
基线IMT、uNTX和IGF-I可评估接受吡格列酮治疗的糖尿病患者的BMD降低风险。
