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Intensive Glycemic Control and Thiazolidinedione Use: Effects on Cortical and Trabecular Bone at the Radius and Tibia.
MedLine Citation:
PMID:  23377193     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Factors that contribute to bone fragility in type 2 diabetes are not well understood. We assessed the effects of intensive glycemic control, thiazolidinediones (TZDs), and A(1C) levels on bone geometry and strength at the radius and tibia. In a substudy of the Action to Control Cardiovascular Risk in Diabetes trial, peripheral quantitative computed tomographic (pQCT) scans of the radius and tibia were obtained 2 years after randomization on 73 participants (intensive n = 35, standard n = 38). TZD use and A(1C) levels were measured every 4 months during the trial. Effects of intervention assignment, TZD use, and A(1C) on pQCT parameters were assessed in linear regression models. Intensive, compared with standard, glycemic control was associated with 1.3 % lower cortical volumetric BMD at the tibia in men (p = 0.02) but not with other pQCT parameters. In women, but not men, each additional year of TZD use was associated with an 11 % lower polar strength strain index (SSIp) at the radius (p = 0.04) and tibia (p = 0.002) in models adjusted for A(1C) levels. In women, each additional 1 % increase in A(1C) was associated with an 18 % lower SSIp at the ultradistal radius (p = 0.04) in models adjusted for TZD use. There was no consistent evidence of an effect of intensive, compared with standard, glycemic control on bone strength at the radius or tibia. In women, TZD use may reduce bone strength at these sites. Higher A(1C) may also be associated with lower bone strength at the radius, but not tibia, in women.
Authors:
Ann V Schwartz; Eric Vittinghoff; Karen L Margolis; Lesley M Scibora; Lisa Palermo; Walter T Ambrosius; Trisha F Hue; Kristine E Ensrud
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-5
Journal Detail:
Title:  Calcified tissue international     Volume:  -     ISSN:  1432-0827     ISO Abbreviation:  Calcif. Tissue Int.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7905481     Medline TA:  Calcif Tissue Int     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
University of California, 185 Berry St., Suite 5700, San Francisco, CA, 94107, USA, aschwartz@psg.ucsf.edu.
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