Trial reportOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2017
Impact of pioglitazone on bone mineral density and bone marrow fat content.
Trial report in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 32 citations in OpenAlex.
- Effects of Exercise on Bone Marrow Adipose Tissue in Children With Overweight/Obesity: Role of Liver Fat.The Journal of clinical endocrinology and metabolism · 2025Trial
- Increased production and reduced urinary buffering of acid in uric acid stone formers is ameliorated by pioglitazone.Kidney international · 2019Trial
- Toxicological profile of anti-diabetic drugs and emerging measures to reduce the toxic burden.Toxicology reports · 2026Review
- Reexamining Fat: Exploring Diversity, Plasticity, Development, Functional Implication, and Therapeutic Options.International journal of molecular sciences · 2026Review
- Non-linear relationship between liver fibrosis and femoral neck bone mineral density in metabolic dysfunction-associated fatty liver disease patients with type 2 diabetes mellitus.Journal of diabetes investigation · 2025Article
- Pathology of Diabetes-Induced Immune Dysfunction.International journal of molecular sciences · 2024Review
- Targeting adipocyte ESRRA promotes osteogenesis and vascular formation in adipocyte-rich bone marrow.Nature communications · 2024Article
- Effect of Antidiabetic Drugs on Bone Health in Patients with Normal Renal Function and in Chronic Kidney Disease (CKD): Insight into Clinical Challenges in the Treatment of Type 2 Diabetes.Journal of clinical medicine · 2023Review
- Risk Factors Associated with Bone Marrow Adiposity Deposition in Postmenopausal Women in the CASH China Study.Diabetes, metabolic syndrome and obesity : targets and therapy · 2023Article
- Saturated and Unsaturated Bone Marrow Lipids Have Distinct Effects on Bone Density and Fracture Risk in Older Adults.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Article
- PFAS and Potential Adverse Effects on Bone and Adipose Tissue Through Interactions With PPARγ.Endocrinology · 2021Review
- Bone Lining Cells Could Be Sources of Bone Marrow Adipocytes.Frontiers in endocrinology · 2021Article
- Antifibrotic Effects of the Thiazolidinediones in Eosinophilic Esophagitis Pathologic Remodeling: A Preclinical Evaluation.Clinical and translational gastroenterology · 2020Article
- The Interplay Between Bone and Glucose Metabolism.Frontiers in endocrinology · 2020Review
- Bone Marrow Adiposity: Basic and Clinical Implications.Endocrine reviews · 2019Review
- Marrow adipose tissue imaging in humans.Bone · 2019Review
- The emerging role of bone marrow adipose tissue in bone health and dysfunction.Journal of molecular medicine (Berlin, Germany) · 2017Review
- Regulation of the immune microenvironment by pioglitazone-loaded polylactic glycolic acid nanosphere composite scaffolds to promote vascularization and bone regeneration.Journal of tissue engineeringArticle
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
Pioglitazone use is associated with an increased risk of fractures. In this randomized, placebo-controlled study, pioglitazone use for 12 months was associated with a significant increase in bone marrow fat content at the femoral neck, accompanied by a significant decrease in total hip bone mineral density. The change in bone marrow fat with pioglitazone use was predominantly observed in female vs. male participants.
introductionUse of the insulin sensitizer pioglitazone is associated with greater fracture incidence, although the underlying mechanisms are incompletely understood. This study aimed to assess the effect of pioglitazone treatment on femoral neck bone marrow (BM) fat content and on bone mineral density (BMD), and to establish if any correlation exists between the changes in these parameters.
methodsIn this double-blind placebo-controlled clinical trial, 42 obese volunteers with metabolic syndrome were randomized to pioglitazone (45 mg/day) or matching placebo for 1 year. The following measurements were conducted at baseline and during the treatment: liver, pancreas, and femoral neck BM fat content (by magnetic resonance spectroscopy), BMD by DXA, abdominal subcutaneous and visceral fat, and beta-cell function and insulin sensitivity.
resultsResults were available for 37 subjects who completed the baseline and 1-year evaluations. At 12 months, BM fat increased with pioglitazone (absolute change, +4.1%, p = 0.03), whereas BM fat content in the placebo group decreased non-significantly (-3.1%, p = 0.08) (p = 0.007 for the pioglitazone-placebo response difference). Total hip BMD declined in the pioglitazone group (-1.4%) and increased by 0.8% in the placebo group (p = 0.03 between groups). The change in total hip BMD was inversely and significantly correlated with the change in BM fat content (Spearman rho = -0.56, p = 0.01) in the pioglitazone group, but not within the placebo group (rho = -0.29, p = 0.24). Changes in BM fat with pioglitazone were predominantly observed in female vs. male subjects.
conclusionsPioglitazone use for 12 months compared with placebo is associated with significant increase in BM fat content at the femoral neck, accompanied by a small but significant decrease in total hip BMD.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.