Decreased bone mineral density in young male veterans on Pioglitazone

Background and objective: Epidemiological and observational studies indicate that thiazolidinedione (TZD) therapy with rosiglitazone and pioglitazone is associated with an increased risk of fractures. The effect of TZDs on bone mineral density (BMD) in men with type 2 diabetes is still in debate. The objective of the study was to investigate changes in BMD and bone turnover markers (BTM) associated with Pioglitazone use in men. Design and Methods: This prospective cross sectional comparative study evaluated the changes in BMD and BTM in male veterans aged less than 55 years, with diabetes with or without use of pioglitazone. In a 6 month follow up study, main outcome measures included BMD at AP spine, femur and wrist; and BTM (osteocalcin and CTx) at a referral center, with no interventions. Results: Pioglitazone use was associated with significant decrease in BMD (annualized %change of >3%) at femoral neck, total hip and 1/3rd radius; increase in CTx by 29% and decrease in osteocalin by 20% at 6months. Conclusions: Even in young men pioglitazone use was associated with bone loss. The changes in BTM suggest effect of pioglitazone on both osteoblast and osteoclast activity.