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More Evidence Links Fractures to Diabetes Drugs

Avandia, Actos Boost Fracture Risk in Older Women, Study Finds

Diabetes Drugs and Fractures: Diabetes Expert View

The study does add to existing information about diabetes drugs and fracture risks, says David Kendall, MD, chief scientific and medical officer of the American Diabetes Association, who reviewed the study for WebMD.

''This is certainly not the first of these larger studies where I would say this unanticipated event was noted," says Kendall, also an associate professor of medicine at the University of Minnesota, Minneapolis.

"Depending on the study, it appears that people who take TZDs for longer periods of time have about a one-and-a-half to twofold increase in their risk of fractures," he says.

Even so, he says, "These are very effective medicines for some patients. We have to understand there are potential risks. Certainly anyone already considered to be at fracture risk -- a woman with osteoporosis -- or someone who suffers from instability or frequent falls, you should think carefully about the use of the medications. On the other hand, fractures in total  [in Herman's study] were generally rare. Far more people didn't have fractures than did have."

In sum, he says, the study finding "is a new piece of information that needs to be taken into consideration when evaluating the potential benefits and risks of your diabetes treatment regimen."

Diabetes Drugs and Fractures: Industry View

Earlier studies have found the same increased risk for fracture, says Mary Anne Rhyne, a spokeswoman for GlaxoSmithKline, which makes Avandia. "Currently the label for Avandia contains a warning/precaution regarding the risk of fractures with Avandia,  usually occurring in the hand, upper arm, or foot, in females. The label further encourages patients to speak with their doctor for advice on how to keep bones healthy."

Ongoing studies may shed more light on the link, Rhyne says.

Takeda Pharmaceuticals, which makes Actos, is conducting a study to examine and better understand the issue of fractures while on the drug, says Elissa Johnsen, a spokeswoman.

The company analyzed the entire database of the Actos clinical trials, she says, and did find increased reports of fracture in women taking Actos compared to comparison groups, but found no increase in fracture risk in men taking Actos. This information is included in the drug's prescribing information, she says.

Diabetes Drugs and Fracture Risk: Take-Home Advice

Those with diabetes on TZD drugs ''should not stop these medicines without talking to their doctor," Herman says.

While he found an increased fracture risk with the drugs, he says, it's not known if treating patients with the bone-builder drugs can decrease the risk.

Until more is known, he says, "in a woman over 50 with diabetes and known osteoporosis, these drugs should be used with caution if at all."


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