Baseline atherosclerosis parameter could assess the risk of bone loss during pioglitazone treatment in type 2 diabetes mellitus.

Abstract

SUMMARY:

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.

INTRODUCTION:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

Baseline IMT, uNTX, and IGF-I could assess the risk of BMD reduction in diabetic patients treated with pioglitazone.

• Authors: I Kanazawa, T Yamaguchi, S Yano, M Yamamoto, M Yamauchi, S Kurioka, T Sugimoto
• Journal: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA (Osteoporos Int) Vol. 21 Issue 12 Pg. 2013-8 (Dec 2010) ISSN: 1433-2965 [Electronic] England
• PMID: 20130841 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Blood Glucose
• Hypoglycemic Agents
• Thiazolidinediones
• urinary N-telopeptide of type I collagen, human
• Osteocalcin
• Insulin-Like Growth Factor I
• Collagen
• Metformin
• Pioglitazone

Topics

• Aged
• Atherosclerosis (diagnostic imaging, metabolism, prevention & control)
• Biomarkers (metabolism)
• Blood Glucose (metabolism)
• Body Weight (drug effects)
• Bone Density (drug effects)
• Collagen (urine)
• Diabetes Mellitus, Type 2 (drug therapy, metabolism, physiopathology)
• Female
• Femur Neck (physiopathology)
• Humans
• Hypoglycemic Agents (adverse effects, therapeutic use)
• Insulin-Like Growth Factor I (metabolism)
• Lumbar Vertebrae (physiopathology)
• Male
• Metformin (adverse effects, therapeutic use)
• Middle Aged
• Osteocalcin (blood)
• Osteoporosis (chemically induced, metabolism, physiopathology)
• Pioglitazone
• Radius (physiopathology)
• Risk Assessment (methods)
• Thiazolidinediones (adverse effects, therapeutic use)
• Ultrasonography