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    More Evidence Links Fractures to Diabetes Drugs

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

    Diabetes Drugs and Fracture Risk: A Closer Look continued...

    The higher the dose, the higher the fracture risk, they found.

    Among the men, only those taking a TZD along with a potent diuretic, called a loop diuretic, were more likely to have a fracture. Taking TZD alone did not appear to increase risk in men.

    Loop diuretics have been linked with bone density decreases, Herman says.

    Why the TZD drugs boost fracture risk may be due to effects such as the reduction of new bone formation or increased bone breakdown, he says.

    The fractures found, he says, ''are not typical osteoporosis fractures," which include those of the spine and hip. They found some spine and hip fractures, but also many lower limb, arm, and leg fractures.

    The study was funded by the CDC and the National Institute of Diabetes and Digestive and Kidney Diseases. Herman has served as a consultant for GlaxoSmithKline, which makes Avandia.

    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."

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