標題: Thiazolidinediones類藥物與骨折風險有關 [打印本頁] 作者: danny 時間: 2009-10-24 17:02 標題: Thiazolidinediones類藥物與骨折風險有關
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
October 6, 2009 — 根據發表在9月號PLoS醫學期刊的一項英國資料庫研究結果，使用Thiazolidinediones類藥物，在校正年齡後，已經證實與骨折風險有關。
來自英國倫敦衛生與熱帶醫學倫敦學院的lan J. Douglas博士及其同事們表示，臨床研究的結果已經證實，使用Thiazolidinediones類抗糖尿病藥物rosiglitazone及pioglitazone與骨折風險增加有關，但是這些研究的統計力量有限。這些研究看到的骨折風險增加顯然僅侷限於女性，且主要牽涉到手臂、手腕、手或是腳：目前並不能完全解釋這些風險的型態。我們的目的在於進一步研究使用Thiazolidinediones類藥物是否與骨折風險有關。
October 6, 2009 — Use of thiazolidinediones has been linked to bone fracture risk, after adjustment for age, according to the results of a UK database study reported in the September issue of PLoS Medicine.
"The results of clinical trials have suggested that the thiazolidinedione antidiabetic agents rosiglitazone and pioglitazone are associated with an increased risk of fractures, but such studies had limited power," write Ian J. Douglas, BSc, MSc, PhD, from the London School of Hygiene and Tropical Medicine, London, United Kingdom, and colleagues. "The increased risk in these trials appeared to be limited to women and mainly involved fractures of the arm, wrist, hand, or foot: risk patterns that could not be readily explained. Our objective was to further investigate the risk of fracture associated with thiazolidinedione use."
Using anonymized primary care data from the computerized UK General Practice Research Database containing clinical records from more than 6 million patients seen at 400 general practices, the investigators identified 1819 individuals at least 40 years old who had a recorded bone fracture and who had been prescribed a thiazolidinedione at least once. In this self-controlled case-series study, within-person rate ratios were determined by comparing the rate of bone fracture in the identified population when these patients were taking a thiazolidinedione drug vs bone fracture rate when they were not taking a thiazolidinedione drug. Results were adjusted for age at the date of fracture, in single-year bands.
For fracture at any site, within-person rate ratio was 1.43 (95% confidence interval [CI], 1.25 - 1.62) comparing exposed vs unexposed periods among patients prescribed any thiazolidinedione. Within-person rate ratio was similar in men and women and with exposure to either rosiglitazone or pioglitazone. The increased risk with thiazolidinedione use was apparent at a range of fracture sites, including the hip, spine, arm, foot, and wrist. Fracture risk was further increased with increasing duration of thiazolidinedione exposure. For 4 years of exposure or longer, rate ratio was 2.00 (95% CI, 1.48 - 2.70).
"Within individuals who experience a fracture, fracture risk is increased during periods of exposure to thiazolidinediones (both rosiglitazone and pioglitazone) compared with unexposed periods," the study authors write. "The increased risk is observed in both men and women and at a range of fracture sites. The risk also increases with longer duration of use."
Limitations of this study include potential sources of bias, observational design, and lack of randomization. In addition, there are inherent difficulties in determining whether a recorded diagnosis in the General Practice Research Database is a new condition or a repeated record of a previous diagnosis.
"We have demonstrated an increased risk of fractures associated with thiazolidinedione treatment," the study authors conclude. "These findings should be taken into consideration in the wider debate surrounding the possible risks and benefits of treatment with thiazolidinediones."
The Wellcome Trust funded this study. Some of the study authors have disclosed various financial relationships with GlaxoSmithKline and/or the Pharmacovigilance Working Party at the European Medicines Agency.
