Clinical Efficacy of Bisphosphonates in Treating Osteoporosis in Diabetes Patients: A Meta-Analysis

 

 Buy Article Permissions and Reprints

Abstract

The aim of the study was to explore the clinical efficacy of bisphosphonates in patients with osteoporosis in diabetes patients by meta-analysis. Six databases were systematically searched from inception to January 30,2023. Studies evaluating the treatment of diabetic osteoporosis with bisphosphonates were included. Key outcome measures, such as bone mineral density (BMD), bone metabolism markers, pain improvement, and safety assessments, were extracted and analyzed. STATA MP V17.0 was used to calculate the combined effect size. After searching Chinese and English databases, 15 studies met the inclusion criteria of this study. The results of the meta-analysis showed that the BMD of patients with osteoporosis in diabetes increased significantly after bisphosphonate treatment, and the lumbar BMD increased by 0.08 g/cm² (95% CI: 0.05–0.11). Femoral neck BMD increased by 0.06 g/cm² (95% CI: 0.01–0.11); Ward’s triangle BMD increased 0.07 g/cm² (95% CI: 0.04–0.09); and trochanter BMD increased by 0.06 g/cm² (95% CI: 0.04–0.08). In addition, bone alkaline phosphatase increased 1.95 μg/l (95% CI: 1.18–2.72), while serum tartrate-resistant acid phosphatase-5b decreased 1.28 U/l (95% CI: –1.81–0.75). Moreover, improvements in pain were statistically significant. The effects of bisphosphonates on osteocalcin (MD: –0.07; 95% CI: –1.12–1.25), serum calcium (MD: 0.01; 95% CI: –0.03–0.04), serum phosphorus (MD: 0.04; 95% CI: –0.03–0.10) and medication safety (OR: 1.75; 95% CI: 1.29–2.37) were not statistically significant. Bisphosphonates have a significant positive effect on bone mineral density and bone metabolism in patients with osteoporosis in diabetes and have good safety.

Publication History

Received: 05 December 2023

Accepted after revision: 24 March 2024

Article published online:
26 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2023; 402: 203-234
  CrossrefPubMedGoogle Scholar
• 2 Mazurenko E, Malyutina S, Shcherbakova L. et al. World congress on osteoporosis, osteoarthritis and musculoskeletal diseases (WCO-IOF-ESCEO 2022). Aging Clin Exp Res 2022; 34: 35-474
  CrossrefPubMedGoogle Scholar
• 3 Dimai HP, Fahrleitner-Pammer A. Osteoporosis and fragility fractures: currently available pharmacological options and future directions. Best Pract Res Clin Rheumatol 2022; 36: 101780
  CrossrefPubMedGoogle Scholar
• 4 Wu B, Fu Z, Wang X. et al. A narrative review of diabetic bone disease: Characteristics, pathogenesis, and treatment. Front Endocrinol (Lausanne) 2022; 13: 1052592
  CrossrefPubMedGoogle Scholar
• 5 Hofbauer LC, Busse B, Eastell R. et al. Bone fragility in diabetes: novel concepts and clinical implications. Lancet Diabetes Endocrinol 2022; 10: 207-220
  CrossrefPubMedGoogle Scholar
• 6 Ebeling PR, Nguyen HH, Aleksova J. et al. Secondary osteoporosis. Endocr Rev 2022; 43: 240-313
  CrossrefPubMedGoogle Scholar
• 7 Wang P, Zhang Y, Shan R. et al. Association between trajectories of fasting plasma glucose and risk of osteoporosis in non-diabetic and diabetic populations. Front Public Health 2022; 10: 960928
  CrossrefPubMedGoogle Scholar
• 8 LeBoff MS, Greenspan SL, Insogna KL. et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 2022; 33: 2049-2102
  CrossrefPubMedGoogle Scholar
• 9 Song S, Guo Y, Yang Y. et al. Advances in pathogenesis and therapeutic strategies for osteoporosis. Pharmacol Ther 2022; 237: 108168
  CrossrefPubMedGoogle Scholar
• 10 Fuggle N, Al-Daghri N, Bock O. et al. Novel formulations of oral bisphosphonates in the treatment of osteoporosis. Aging Clin Exp Res 2022; 34: 2625-2634
  CrossrefPubMedGoogle Scholar
• 11 McConnell M, Shieh A. Polypharmacy in osteoporosis treatment. Clin Geriatr Med 2022; 38: 715-726
  CrossrefPubMedGoogle Scholar
• 12 Wang M, Wu YF, Girgis CM. Bisphosphonate drug holidays: evidence from clinical trials and real-world studies. JBMR Plus 2022; 6: e10629
  CrossrefPubMedGoogle Scholar
• 13 Chen PW, Su HY, Tu YK. et al. Association of bisphosphonates with diabetes risk and glycemic control: a meta-analysis. Osteoporos Int 2023; 34: 387-397
  CrossrefPubMedGoogle Scholar
• 14 Xiong Z, Yi P, Tang X. et al. Meta-analysis of the efficacy and safety of alendronate combined with atorvastatin in the treatment of osteoporosis in diabetes mellitus. Biomed Res Int 2022; DOI: 10.1155/2022/6747469.
  CrossrefPubMedGoogle Scholar
• 15 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
  CrossrefPubMedGoogle Scholar
• 16 Tong J, Chen Z, Sun G. et al. The efficacy of pulsed electromagnetic fields on pain, stiffness, and physical function in osteoarthritis: a systematic review and meta-analysis. Pain Res Manag 2022; DOI: 10.1155/2022/9939891.
  CrossrefPubMedGoogle Scholar
• 17 Huang Q, Lin J, Han R. et al. Using virtual reality exposure therapy in pain management: a systematic review and meta-analysis of randomized controlled trials. Value Health 2022; 25: 288-301
  CrossrefPubMedGoogle Scholar
• 18 Dai C, Liang G, Zhang Y. et al. Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17: 161
  CrossrefPubMedGoogle Scholar
• 19 Hesari E, Sanjari M, Mansourzadeh MJ. et al. Osteoporosis medication adherence tools: a systematic review. Osteoporos Int 2023; 34: 1535-1548
  CrossrefPubMedGoogle Scholar
• 20 Dagdelen S, Sener D, Bayraktar M. Influence of type 2 diabetes mellitus on bone mineral density response to bisphosphonates in late postmenopausal osteoporosis. Adv Ther 2007; 24: 1314-1320
  CrossrefPubMedGoogle Scholar
• 21 Iwamoto J, Sato Y, Uzawa M. et al. Retracted: three-year experience with alendronate treatment in postmenopausal osteoporotic Japanese women with or without type 2 diabetes. Diabetes Res Clin Pract 2011; 93: 166-173
  CrossrefPubMedGoogle Scholar
• 22 Deng LL, Chen HL, Li MS. Therapeutic effect of alendronate plus caltrate or caltrate alone in type 2 diabetic elderly women with osteoporosis. Chin J Osteopor 2010; 16: 132-135
  PubMedGoogle Scholar
• 23 Wang YL, Wang HB, Yang F. et al. The effect of alendronate on bone biochemical indicator of Type 2 DM postmenopausal women with lower BMD. J Clin Intern Med 2006; 23: 595-597
  PubMedGoogle Scholar
• 24 Wang HY, Cai XY, Ge J. et al. Effect of Risedronate on type 2 diabetes mellitus complicated with postmenopausal osteoporosis. Shanghai Med J 2006; 29: 429-431
  PubMedGoogle Scholar
• 25 Maugeri D, Panebianco P, Rosso D. et al. Alendronate reduces the daily consumption of insulin (DCI) in patients with senile type I diabetes and osteoporosis. Arch Gerontol Geriatr 2002; 34: 117-122
  CrossrefPubMedGoogle Scholar
• 26 Keegan TH, Schwartz AV, Bauer DC. et al. Effect of alendronate on bone mineral density and biochemical markers of bone turnover in type 2 diabetic women: the fracture intervention trial. Diabetes Care 2004; 27: 1547-1553
  CrossrefPubMedGoogle Scholar
• 27 Han RY, Wu ZZ, Liu SJ. et al. Efficacy of zoledronic acid plus caltrate don in the treatment of diabetic osteoporosis. Prog Mod Biomed 2015; 15: 104-106
  PubMedGoogle Scholar
• 28 Ren H, Zhang ZL, Cai W. et al. Efficacy of zoledronic acid combined with calcium carbonate D3 in the treatment of diabetic osteoporosis and its effects on bone mineral density and bone metabolism indexes. Hebei Med 2020; 26: 45-50
  PubMedGoogle Scholar
• 29 Hu Q, Wang Q, Liu F. et al. Combination of calcitriol and zoledronic acid on PINP and β-CTX in postoperative patients with diabetic osteoporosis: a randomized controlled trial. Dis Markers 2022; DOI: 10.1155/2022/6053410.
  CrossrefPubMedGoogle Scholar
• 30 Guo YJ, Wu J. Effect of alendronate combined with insulin on the treatment of diabetic osteoporosis. J Clin Med Pract 2019; 23: 69-72
  PubMedGoogle Scholar
• 31 Ye CC, Jiang H, Pan LQ. Alendronate sodium combined with insulin for osteoporosis in patients with type 2 diabetes mellitus. Chin J Gen Pract 2017; 15: 1714-1717
  PubMedGoogle Scholar
• 32 Chen H. Observation on effect of alendronate combined with calcarea carbonica D_3 tablet in the treatment of type 2 diabetic osteoporosis. Chin J Pharmacoepidemiol 2015; 24: 451-453 + 459
  PubMedGoogle Scholar
• 33 Li WQ, Shi CH. Effects of alendronate sodium combined with calcium carbonate D3 tablets on bone mineral density and bone metabolism indexes in patients with diabetic osteoporosis. J Guangxi Med Univ 2016; 33: 831-833
  PubMedGoogle Scholar
• 34 Wang F, Ren HQ, Shen XB. Effect of insulin combined alendronate sodium on bone mineral density and levels of serum BAP TRAP-5b and BGP in aged patients with type 2 diabetes mellitus with osteoporosis. J Hainan Med Univ 2016; 22: 1387-1389+1393
  PubMedGoogle Scholar
• 35 Sheu A, Greenfield JR, White CP. et al. Assessment and treatment of osteoporosis and fractures in type 2 diabetes. Trends Endocrinol Metab 2022; 33: 333-344
  CrossrefPubMedGoogle Scholar
• 36 Schwartz AV, Backlund JC, de Boer IH. et al. Risk factors for lower bone mineral density in older adults with type 1 diabetes: a cross-sectional study. Lancet Diabetes Endocrinol 2022; 10: 509-518
  CrossrefPubMedGoogle Scholar
• 37 Duhan N, Siwach RC, Yadav K. et al. Expression of concern: comparative evaluation of isosorbide mononitrate and alendronate in management of postmenopausal osteoporosis. Arch Gynecol Obstet 2023; 308: 1655
  CrossrefPubMedGoogle Scholar
• 38 Everts-Graber J, Bonel H, Lehmann D. et al. Comparison of anti-fracture effectiveness of zoledronate, ibandronate and alendronate versus denosumab in a registry-based cohort study. Osteoporos Int 2023; 34: 1961-1973
  CrossrefPubMedGoogle Scholar
• 39 Zhou Q, Guan Z, Liu S. et al. The effects of metformin and alendronate in attenuating bone loss and improving glucose metabolism in diabetes mellitus mice. Aging (Albany NY) 2022; 14: 272-285
  CrossrefPubMedGoogle Scholar
• 40 Balaji A, Boratne AV, Mishra A. Reducing risk of type 2 diabetes mellitus with alendronate - a promising possibility for the Indian population. Indian J Pharmacol 2022; 54: 65-66
  CrossrefPubMedGoogle Scholar
• 41 Viggers R, Al-Mashhadi Z, Starup-Linde J. et al. Alendronate use and risk of type 2 diabetes: a nationwide Danish nested case-control study. Front Endocrinol (Lausanne) 2021; 12: 771426
  CrossrefPubMedGoogle Scholar