Could a bisphosphonate prevent type 2 diabetes?

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Treatment with a common osteoporosis drug could help prevent diabetes, new research shows.

In a nationwide case-control study, adults treated with bisphosphonate alendronate (Fosamax) at any time in their life had a 36% lower chance of developing type 2 diabetes compared to people who never had used alendronate (adjusted OR 0.64, 95% CI 0.62-0.66), reported Rikke Viggers, MD, of Aalborg University Hospital in Denmark.

Also, the longer a person took alendronate seemed to further increase protection, as there was a significant dose-response relationship between longer use of the osteoporosis drug and a reduced risk of diabetes, Viggers noted. at the Virtual European Association for the Study Meeting on Diabetes.

Specifically, those who were treated with the drug for more than 8 years – the longest level of use included in the analysis – saw a 53% reduction in the risk of developing diabetes (OR 0.47, 95% CI 0.40-0.56), she said. . “These data suggest that alendronate may have the potential to prevent or protect against the further development of type 2 diabetes in a dose-dependent manner.”

In addition, higher rates of treatment adherence, which were estimated by dividing the cumulative dose of the drug by the duration of treatment, were also linked to a lower risk of diabetes. This was quantified as a drug possession ratio, she said. “While not significant, it appears that higher compliance may be linked to lower risk of type 2 diabetes.”

Viggers noted that the results are not particularly surprising, since two previous population-based studies had reported a similar relationship.

“It seems that glucose and bone metabolism affect each other,” Viggers said. “People with diabetes have decreased bone turnover, and a high number of these patients have osteoporosis and an increased risk of fracture, even though DXA bone density readings are normal.”

For the analysis, Viggers and his co-investigator relied on data from the Danish National Patient Register. A total of 163,588 adults with type 2 diabetes were included, who were diagnosed with diabetes between 2008 and 2018; people with type 1 diabetes were excluded from the analysis. The diabetes condition was identified using the ICD-10 code and the drug prescriptions exchanged with an ATC code of a hypoglycemic drug in the health services prescription register.

Patients with type 2 diabetes were then matched in a 3: 1 ratio based on age and sex, for a total of 490,764 matched control subjects. About 55% of the cohort were men and the mean age was 67 years.

Compared to matched controls, adults with type 2 diabetes were more likely to be heavy smokers; abuse alcohol; suffer from obesity, pancreatitis, hyperthyroidism or hypothyroidism; use glucocorticoids; and have a higher mean Charlson Comorbidity Index score.

Viggers said that while the results are promising, questions remain about the exact mechanism of action that would explain the relationship, although there are suggestions that inflammation and oxidative stress could be involved.

The next steps in her research, she said, include further evaluation of the intersection between insulin sensitivity, bone indices and glycemic control, comparing measurements in healthy people, those with prediabetes and those with type 2 diabetes. She also hopes to determine whether alendronate is the optimal anti-osteoporosis treatment for patients with type 2 diabetes.

The limitations of the study, Viggers noted, included a lack of data on physical activity levels, body mass index and vitamin D use, which could potentially alter the results.

  • Kristen Monaco is editor-in-chief, specializing in news in endocrinology, psychiatry and nephrology. Based in the New York office, she has been with the company since 2015.

Disclosures

The study was funded by a Steno Collaborative grant from the Novo Nordisk Foundation.

Viggers reported a relationship with the Novo Nordisk Foundation.


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