Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Osteoporos Int. 2017 Nov;28(11):3261-3269. doi: 10.1007/s00198-017-4164-3. Epub 2017 Jul 22.
Pioglitazone use is associated with an increased risk of fractures. In this randomized, placebo-controlled study, pioglitazone use for 12 months was associated with a significant increase in bone marrow fat content at the femoral neck, accompanied by a significant decrease in total hip bone mineral density. The change in bone marrow fat with pioglitazone use was predominantly observed in female vs. male participants.
Use of the insulin sensitizer pioglitazone is associated with greater fracture incidence, although the underlying mechanisms are incompletely understood. This study aimed to assess the effect of pioglitazone treatment on femoral neck bone marrow (BM) fat content and on bone mineral density (BMD), and to establish if any correlation exists between the changes in these parameters.
In this double-blind placebo-controlled clinical trial, 42 obese volunteers with metabolic syndrome were randomized to pioglitazone (45 mg/day) or matching placebo for 1 year. The following measurements were conducted at baseline and during the treatment: liver, pancreas, and femoral neck BM fat content (by magnetic resonance spectroscopy), BMD by DXA, abdominal subcutaneous and visceral fat, and beta-cell function and insulin sensitivity.
Results were available for 37 subjects who completed the baseline and 1-year evaluations. At 12 months, BM fat increased with pioglitazone (absolute change, +4.1%, p = 0.03), whereas BM fat content in the placebo group decreased non-significantly (-3.1%, p = 0.08) (p = 0.007 for the pioglitazone-placebo response difference). Total hip BMD declined in the pioglitazone group (-1.4%) and increased by 0.8% in the placebo group (p = 0.03 between groups). The change in total hip BMD was inversely and significantly correlated with the change in BM fat content (Spearman rho = -0.56, p = 0.01) in the pioglitazone group, but not within the placebo group (rho = -0.29, p = 0.24). Changes in BM fat with pioglitazone were predominantly observed in female vs. male subjects.
Pioglitazone use for 12 months compared with placebo is associated with significant increase in BM fat content at the femoral neck, accompanied by a small but significant decrease in total hip BMD.
吡格列酮的使用与骨折风险增加有关。在这项随机、安慰剂对照研究中，吡格列酮使用 12 个月与股骨颈骨髓脂肪含量显著增加有关，同时总髋部骨密度显著降低。与吡格列酮使用相关的骨髓脂肪变化主要发生在女性参与者中，而非男性参与者。
使用胰岛素增敏剂吡格列酮与更高的骨折发生率相关，尽管其潜在机制尚不完全清楚。本研究旨在评估吡格列酮治疗对股骨颈骨髓（BM）脂肪含量和骨密度的影响，并确定这些参数变化之间是否存在任何相关性。
在这项双盲安慰剂对照临床试验中，42 名患有代谢综合征的肥胖志愿者被随机分配至吡格列酮（45mg/天）或匹配的安慰剂组，治疗 1 年。在基线和治疗期间进行了以下测量：肝脏、胰腺和股骨颈 BM 脂肪含量（通过磁共振波谱法）、DXA 测定的骨密度、腹部皮下和内脏脂肪以及β细胞功能和胰岛素敏感性。
37 名完成基线和 1 年评估的受试者的结果可用。在 12 个月时，BM 脂肪随着吡格列酮的使用而增加（绝对变化，+4.1%，p=0.03），而安慰剂组的 BM 脂肪含量无显著减少（-3.1%，p=0.08）（吡格列酮-安慰剂反应差异的 p 值为 0.007）。吡格列酮组全髋骨密度下降（-1.4%），安慰剂组增加 0.8%（组间比较 p=0.03）。吡格列酮组全髋骨密度的变化与 BM 脂肪含量的变化呈显著负相关（Spearman rho=-0.56，p=0.01），而安慰剂组无相关性（rho=-0.29，p=0.24）。与吡格列酮相关的 BM 脂肪变化主要发生在女性参与者中，而非男性参与者。
与安慰剂相比，吡格列酮使用 12 个月与股骨颈骨髓脂肪含量显著增加有关，同时总髋部骨密度略有但显著降低。
