Thiazolidinediones (TZD) Bone Loss and the Effects on Bone Marrow Differentiation and Osteoblast Formation
Thiazolidinediones (TZD) Bone Loss and the Effects on Bone Marrow Differentiation and Osteoblast Formation
Thiazolidinediones (TZDs) are a commonly used antidiabetic drugs currently used by over a
 million patients in the United States. Recent studies have shown that treatment with TZD may
 increase the risk of bone fractures. The cause of bone loss is not known. We believe that TZD
 may cause increased accumulation of fat in the bone marrow, which may cause decrease bone
 formation and weak bones. .
This study aims to determine if TZDs increase the amount of fat and decrease the number of
 bone producing cells in the bone marrow.

 A total of 5 subjects who require surgery for mandible (jaw) fracture and bone graft will be
 recruited. Some patients who will undergo mandible surgery will require a bone graft. In this
 procedure, a small piece of bone from the hip is placed in the mandible. In this study, a
 small amount of bone marrow fluid (5 mL or 1 teaspoon) will be obtained after the bone graft
 is completed. Obtaining the bone marrow will not result in additional pain or health
 problems. The effect of TZD on bone marrow and bone forming cells will be studied. The cells
 obtained during surgery will be grown at Dr Beck's laboratory at Emory University School of
 Medicine.

 A working hypothesis suggests that the increased fracture risk in patients taking TZDs is the
 result of TZDs altering the differentiation capacity of bone marrow stromal cells pushing
 them towards the adipocyte lineage at the cost of osteoblast formation thereby decreasing
 bone formation.

 Study AIM:To determine whether TZD exposure in vitro alters bone formation and the
 differentiation capacity of bone marrow stromal cells by promoting adipocyte lineage
 differentiation and lowering osteoblast formation.
Inclusion Criteria:

 1. Males or females between the ages of 18 and 80 years undergoing ileac crest bone graft
 to repair traumatic mandible fracture.

 2. Patients admitted for elective or emergency surgery or trauma.

 Exclusion Criteria:

 1. Subjects with history of decompensated diabetes (blood glucose > 200 mg/dl)

 2. Critically ill patients with multi-organ failure, relevant hepatic disease or impaired
 renal function (serum creatinine ≥ 2.0 mg/dl)

 3. HIV

 4. Hemolytic anemia and/or hematocrit < 28%

 5. Mental condition rendering the subject unable to understand the nature, scope, and
 possible consequences of the study

 6. Pregnancy