Endocrine Abstracts

Introduction: Type 2 diabetes mellitus (T2DM) and osteoporosis may co-exist in the same individual. However, the exact effect of anti-osteoporotic treatment on glucose metabolism is unknown. We aimed to systematically review the effects of anti-osteoporotic medications on glucose metabolism and the incidence of T2DM.

Methods/design: PubMed, Cochrane and EMBASE were systematically searched until the 31 of December, 2017.

Results: Bisphosphonates (n=2): One retrospective cohort study (n=35 998, follow-up: 42 months) showed a significant reduction in T2DM risk in individuals exposed to bisphosphonates, compared with age-, sex- and body mass index (BMI)-matched controls. The other retrospective cohort study (n=23 976) did not show any significant effect (follow-up: 4.2 years).

Alendronate (n=3): In one randomized placebo-controlled trial (RCT), no difference in fasting plasma glucose (FPG) concentrations or T2DM incidence was observed between postmenopausal women assigned to alendronate (n=3084) or placebo (n=3067), after four years. In one retrospective case-control (n=1011) and one cohort study (n=55 090), patients exposed to alendronate showed a reduced incidence of T2DM, compared with no treatment (mean time of exposure: 3.8 years).

Zoledronic acid (n=2): One RCT (n=3537, follow-up: four years) and one prospective study (n=24, follow-up: 1 year) did not show any effect on glucose metabolism in non-diabetic osteoporotic postmenopausal women.

Denosumab (n=3): One RCT (n=3535, follow-up: three years) and two prospective studies (n=38 and n=14, follow-up: 24 and 12 weeks, respectively) did not show any effect on FPG or T2DM incidence.

Teriparatide (n=3): One study (n=23) showed an increase in FPG and insulin resistance (IR), after six months of treatment. Two other prospective studies (n=14 and n=25) did not show any effect.

Strontium ranelate (n=1): One study (n=40, follow-up: 12 months) did not show any effect on FPG.

Raloxifene (n=17). Only one prospective study in T2DM (n=37, follow-up: six months) showed a decrease in HbA1c levels. Two RCTs in non-diabetic patients (n=44 and n=30, follow-up: two and six months, respectively) showed a decrease in FPG and IR.

Bazedoxifene (n=1): One prospective study (n=20) did not show any effect in T2DM patients, regarding FPG or IR after 12 weeks of treatment.

Conclusions: Bisphosphonates and raloxifene exert either neutral or beneficial effects on glucose metabolism. Neutral or detrimental effects have been reported for teriparatide. Neutral effects have been also observed with denosumab, basedoxifene and strontium ranelate, although these data derive mainly from small prospective studies of short duration. The reduction in T2DM risk with bisphosphonates warrants further investigation.