Will Statin Use Prevent Fracture of Type 2 Diabetes Associated with Thiazolidinedione Treatment? A Mini-Review and a Hypothesis

Thiazolidinediones (TZDs) are a multi-effective anti-glycemic drug for type 2 diabetes. Recent clinical trials suggest TZDs are associated with bone loss or fracture in older diabetic women. Diabetic women exhibit more rapid bone loss despite the higher baseline bone mineral density. The higher fracture risk of type 2 diabetes may be associated with neural and vascular complications, or the fragile bone structure. Statins were found to exert protective effects on bone through their anti-oxidative effect on vascular and advanced glyca- tion end product-related disorders. The impact of combination use of statins and TZDs on bone however has never been addressed. Whereas considering the advantages of statins and TZDs in treating type 2 diabetes regarding their cardiovas- cular protection and glycemic control improvement, we hypothesize that the concomitant use of statins and TZDs might also prevent against bone complications of type 2 diabetes or induced by TZDs, especially for older diabetic women.