A new study of Avandia has found that patients taking the diabetes drug had a significantly increased risk of heart failure and bone fractures. The study, known as RECORD, was presented at an annual meeting of the American Diabetes Association and published online in the medical journal The Lancet.

The RECORD study found that patients who were prescribed Avandia and a combination of two other diabetes medications were at roughly twice the risk of heart failure and at a greater risk of death from heart failure, according to Dr. Philip D. Home, the chairman of the study’s steering committee and an expert in diabetes medicine.

In addition, the study found a much higher rate of fractures among women in the Avandia group. The additional group of patients in the study were only prescribed the other two diabetes medications.

Concerns about the safety of Avandia first arose in 2007, when a study published in the New England Journal of Medicine found an increased risk of heart attacks in Avandia users. These results, combined with several additional studies which indicated an increased risk of heart attack, heart failure and death among Avandia users prompted the Food and Drug Administration to issue new warnings about the drug.

Both the American Diabetes Association and the European Association for the Study of Diabetes have advised doctors against prescribing the drug. The consumer advocacy group Public Citizen has also called on the FDA to issue an Avandia recall.