Use of thiazolidinediones and the risk of elective hip or knee replacement: a population based case-control study

Abstract

BACKGROUND: Osteoarthritis (OA) is the most common musculoskeletal condition in the elderly population. However, no disease modifying drug exists for this disease. In vivo animal studies have suggested that thiazolidinediones (TZD) may be used as disease modifying osteoarthritis drugs (DMOADs). To our knowledge, this has not yet been examined in humans before. OBJECTIVE: To determine the risk of total joint replacement (TJR) in patients using TZDs compared to diabetic patients using other antidiabetic drugs. METHODS: A population based case-control study was performed using the Clinical Practice Research Datalink (CPRD). Cases (n = 94,609) were defined as patients >18 years of age who had undergone total knee (TKR) or hip replacement (THR) between 2000 and 2012. Controls were matched by age, gender and practice/surgery. Conditional logistic regression analyses were used to estimate the risk of TKR and THR with the use of TZDs in patients currently using one or more antidiabetic drugs. In order to determine effect with prolonged use, we also stratified TZD users by total number of prescriptions prior to surgery. We statistically adjusted our analyses for lifestyle factory, comorbidities and concomitant drug use. RESULTS: There was no difference in risk of TKR (OR = 1.09 (95% CI = 0.93-1.27)) and THR (OR = 0.92 (95% CI = 0.76-1.10)) when TZD users are compared to other AD users. Furthermore, we did not find an association with prolonged use of TZDs and TJR. CONCLUSION: Despite promising results from animal in vivo studies, this study did not find any evidence for a disease modifying osteoarthritic effect of TZDs.