Prescribing Advice for GPs

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Study confirms glitazone bone problems

The Journal of Clinical Endocrinology and Metabolism has published the results of a fourteen-week study that has confirmed that rosiglitazone does have detrimental effects on bone formation and bone mineral density (BMD).

There have been concerns raised recently regarding fractures in women taking rosiglitazone and pioglitazone.

This study recruited 50 healthy and postmenopausal women. Using double blind trial design the intervention of rosiglitazone (8mg/day) was compared to placebo with random treatment allocation.

The study found statistically significant reductions in two markers of bone formation activity (procollagen type I N-terminal propeptide and osteocalcin) and also in BMD measured at the hip. There was a statistically significant decrease in BMD at the spine compared to baseline data but the difference between the two groups was not significant.

The study concludes that all future long-term trials of the glitazones should include end points assessing skeletal outcomes. This may include assessing rates of fractures as well as markers of bone formation, quality and BMD.

Action: Particularly in female patients, fracture risk and general bone health should be considered before starting treatment with any glitazone and during medication reviews for patients already on treatment. Alternative treatment, for example with a sulphonylurea, may be appropriate where fracture risk is considered to be high.

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