A large Canadian study involving more than 80,000 people has found that thiazolidinedione drugs may cause a higher risk of fractures than sulfonylurea drugs (Arch Intern Med, 169[15]:1395-1402). Both classes of drugs are used to treat type 2 diabetes. Thiazolidinediones include rosiglitazone (Avandia) and pioglitazone (Actos). Sulfonylureas include glimepiride, glipizide, and others.
   The mean age of patients included in the study was 59. Somewhat less than one-half (43%) were women. Results showed that treatment with a thiazolidinedione was linked to a 28% increase in risk of peripheral fracture compared with treatment with a sulfonylurea. Pioglitazone was linked to a 77% increase in the risk of peripheral fracture.
   The study's authors conclude that thiazolidinediones may cause a higher risk of fractures than sulfonylureas, and that pioglitazone may produce a higher risk than rosiglitazone maleate. The authors suggest larger observational trials and full publication of all fracture data from other clinical trials.

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