It is well recognized that thiazolidinediones like rosiglitazone represent a somewhat new class of drug for the treatment of type 2 diabetes, as they have been shown to have a positive impact on cardiometabolic risk factors. However, increased bone fractures might be a potential side effect of rosiglitazone. In the ADOPT (A Diabetes Outcome Progression Trial) trial, which used a randomized design, Kahn et al. had previously compared the effects of rosiglitazone, metformin, and glyburide on glycemic control of patients with type 2 diabetes. In these post-hoc analyses, they compared the effects of these drugs on fracture incidence in 1,840 women and 2,511 men. The fracture rates did not differ among treatment groups in men. In women, more fractures were reported with rosiglitazone, with 15.1% of women treated with this drug experiencing a fracture over a 5-year follow up compared to 7.3% and 7.7%, respectively, for metformin and glyburide-treated women. Compared to women treated with metformin and glyburide, the odds ratio for fracture incidence was 1.81 (95% CI, 1.17-2.80) in women treated with rosiglitazone. Because women treated with rosiglitazone had a twofold increased risk of fracture, the authors suggested that risk of fracture should be taken into consideration when prescribing rosiglitazone, especially in female patients. Special focus should also be placed on bone health in these patients.
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