Muhammed Bahaddin DURAK, Alpay YEŞİLALTAY

The effect of long-term use of pioglitazone on bone mineral density in patients with diabetes mellitus

Aims: This study aimed to explore the incidence of osteoporosis in patients with diabetes mellitus (DM) who have been on a long-term pioglitazone regimen, and to ascertain the link between pioglitazone usage and the onset of osteoporosis. Methods: We enrolled patients prospectively and conducted a comparative analysis between two groups of DM patients: those who had been using pioglitazone for a period exceeding two years, and those with no history of pioglitazone use. Bone Mineral Density (BMD) was assessed using dual energy X-ray absorptiometry (DEXA). Results: There were no significant differences in age, gender, disease duration, fasting plasma glucose levels, and HbA1c levels between pioglitazone users and non-users. However, a significant variation was found in the BMD measurements. Patients on pioglitazone had an L1-L4 vertebra BMD T-score of -1.3, compared to -0.9 in non-users (p<0.05), signifying a substantial divergence in BMD between both cohorts. Furthermore, it was observed that patients with a disease duration of less than 10 years had higher BMD T-scores compared to those with disease durations exceeding 10 years, suggesting a decrease in BMD with increased disease longevity. Moreover, a higher BMD was observed in patients aged less than 50 years in comparison to those aged over 60 years. Conclusion: Despite the clinical preference for pioglitazone in the management of DM and insulin resistance, our findings suggest that it may affect bone metabolism adversely in the long run. Hence, careful monitoring is advised during extended periods of pioglitazone use. To investigate the incidence of osteoporosis in patients with DM who use pioglitazone for a long time and to determine the relationship between pioglitazone and the cause of this osteoporosis.

Keywords:

Pioglitazone bone mineral density, diabetes mellitus,

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