February 18, 2010

Yes: Actos and Avandia Cause a Huge Increase in Fracture Risk

I've blogged about the way Avandia and Actos cause osteoporosis and broken bones before. I've also documented this on the page where I summarize all the research that makes it clear how dangerous both these drugs are, which you can read HERE.

But I wanted to bring your attention to a new cohort study involving 19,070 patients with diabetes, which was published in the Journal of Clinical Endocrinology and Metabolism. It quantifies just how big the fracture risk of these drugs really is.

Thiazolidinedione Use and the Longitudinal Risk of Fractures in Patients with Type 2 Diabetes Mellitus Zeina A. Habib et al. JClinEndo&Metab Vol. 95, No. 2 592-600 doi:10.1210/jc.2009-1385

As summarized in the newsletter, Endocrine Today, researchers
... studied 19,070 patients at Henry Ford Hospital in Detroit between January 2000 and May 2007. The study group included 9,620 women and 9,450 men.

During the study period, 4,511 patients had at least one prescription filled for a TZD. The investigators used electronically maintained medical claims data to identify nontraumatic bone fractures.

TZD use was associated with an increased risk for fracture in the overall cohort (adjusted HR=1.35; 95% CI, 1.05-1.71) and in women (HR=1.57; 95% CI, 1.16-2.14). Men, regardless of age, were not at an increased risk for fractures (HR=1.05; 95% CI, 0.70-1.58).

Women aged 65 years and older appeared to be at the greatest risk for fracture (HR=1.72; 95% CI, 1.17-2.52).

They found that the increased risk for fracture in women appeared after approximately one year of TZD use.
Before you conclude that this means this is a safe drug for men and younger women, you need to remember that fractures due to osteoporosis only occur after bone has been significantly weakened. Older women already have weak bones so any factor that weakens them further will stand out.

But the chances are very good that these drugs are causing osteoporotic changes in patients with denser bones and that over time they too will find themselves with dangerously fragile bones.

The reason we know this is that we know WHY these drugs cause osteoporosis. It is because the mechanism they use transforms stems cells that would normally become baby bone cells into baby fat cells. You can read more about this mechanism HERE.

With what we already know about how these drugs cause edema and promote heart failure in people who did not have it before they started the drug this latest very large study should make it crystal clear that this is not a good drug to take. Once you've rotted out your long bones, you face a lifetime of limited mobility that undoes any minor change in blood sugar they may make. And they only make a very small change in blood sugar. Not enough to take this kind of risk.

If your doctor still insists this is a safe drug, print out the information you'll find HERE and for an explanation of why you should be ignoring it.



Anne said...

Did you read the recent NYT article about Avandia and heart problems? http://www.nytimes.com/2010/02/20/health/policy/20avandia.html?pagewanted=1&hp

I was surprised this article says that using Actos would save lives. I thought Actos had similar problems as Avandia.

Fractures were not mentioned in this article.

Jenny said...


Actos does not have the same high rate of heart attacks as Avandia, but it DOES cause the same high rate of heart failure including heart failure in people who were healthy when they started the drug.

For some reason, the health press keeps ignoring that, though the data is compelling. That is why I send people to read the page I put on the main site where they can see the side effects documented for both drugs.