Harvard Women's Health Watch

In the journals: Study confirms link between certain diabetes drugs and fractures

For several years, concerns have been mounting about the safety of a class of drugs known as thiazolidinediones (TZDs), used to treat type 2 diabetes. In 2007, after research found a higher rate of heart failure among people who took the TZDs rosiglitazone (Avandia) and pioglitazone (Actos), the FDA required a "black box" warning label on these medications. Other studies have prompted further worries: a 43% higher risk of heart attack in people who took rosiglitazone, as well bone loss and fractures in people — particularly women — taking either rosiglitazone or pioglitazone.

Now a study has confirmed the finding on fractures. Researchers at Henry Ford Hospital in Detroit, Mich., examined data on 19,000 people in a Michigan health maintenance organization who were taking an oral antidiabetes drug for type 2 diabetes. After allowing for the effects of possible confounding variables, including age, ethnicity, and other health problems, researchers found a 57% increased risk of fracture among women taking TZDs (almost one-quarter of the participants), compared with women not taking those drugs. The excess risk appeared only after a year of treatment and was particularly high (72%) in women over age 65. No such link was seen in men. The study was published in the February 2010 Journal of Clinical Endocrinology and Metabolism.

Oral medications* to control blood sugar

Drug class



glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Diabeta, Glynase, Micronase), tolbutamide (Orinase)


metformin (Glucophage)

Alpha-glucosidase inhibitors

acarbose (Precose), miglitol (Glyset)


nateglinide (Starlix), repaglinide (Prandin)

Amylin analogue

pramlintide (Symlin)

DPP-IV inhibitor

sitagliptin (Januvia)

*Other than thiazolidinediones (TZDs).

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