全球精选文摘 - 2型糖尿病患者中噻唑烷二酮类药物的使用与骨折纵向风险之间的关系

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2型糖尿病患者中噻唑烷二酮类药物的使用与骨折纵向风险之间的关系

Thiazolidenedione Use and the Longitudinal Risk of Fractures in Patients with Type 2 Diabetes Mellitus

Habib ZA, Havstad SL, Wells K 2010/4/30 15:16:01

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J Clin Endocrinol Metab, 2010,

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Context:
Thiazolidinedione (TZD) use has recently been associated with an increased risk of fractures.

Objective:
The aim of this study was to determine the time-dependent relationship between TZD use and fracture risk.

Design:
We conducted a retrospective cohort study in a large health system in southeast Michigan.

Patients:
Patients who received care from the health system were included if they were at least 18yr of age, had a diagnosis of diabetes, and had at least one prescription for an oral diabetes medication. These criteria identified 19,070 individuals (9,620 women and 9,450 men).

Intervention:
This study compared patients treated with TZDs to patients without TZD treatment. Cox proportional hazard models were used to assess the relationship between exposure and outcomes.

Main Outcome Measures:
The primary outcome was the time to fracture. Secondary analyses examined the risk of fractures in subgroups defined by sex and age.

Results:
TZD use was associated with an increased risk of fracture in the cohort overall [adjusted hazard ratio (aHR), 1.35; 95% confidence interval (CI), 1.05–1.71] and in women (aHR, 1.57; 95% CI, 1.16–2.14), but not in men (aHR, 1.05; 95% CI, 0.70–1.58). Women more than 65yr of age appeared to be at greatest risk for fracture (aHR, 1.72; 95% CI, 1.17–2.52). Among women, the increased fracture risk was not apparent until after 1yr of TZD treatment.

Conclusions:
TZD use was associated with an increased risk for fractures in women, particularly at ages above 65yr. Clinicians should be aware of this association when considering TZD therapy so as to appropriately manage and counsel their patients.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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