Managing bone health in patients with type 2 diabetes mellitus (T2DM) remains challenging because of increased fracture risk and altered bone quality associated with the disease. A prospective, open-label, nonrandomized clinical study published in Endocrine Practice compared the antiosteoporotic efficacy of zoledronic acid (ZOL) and denosumab (DEN) in women with T2DM and osteoporosis.

The study included 120 osteoporotic women with T2DM aged 50 to 80 years. Forty-five participants received ZOL and 75 received DEN based on patient preference. Efficacy endpoints included percent change from baseline in bone mineral density (BMD) at the femoral neck, lumbar spine, and total hip after 1 year. Bone turnover markers and fracture risk assessed using the fracture risk assessment tool (FRAX) were also evaluated.

Findings

• DEN produced greater femoral neck BMD improvement than ZOL after 1 year (least-squares mean difference 4.59% [95% confidence interval (CI), 0.93% to 8.25%]; P=0.017).
• Lumbar spine and total hip BMD changes were similar between treatment groups.
• Osteocalcin suppression was greater with DEN (least-squares mean difference −20.58% [95% CI, −39.93 to −1.24]; P=0.041).
• FRAX showed greater reduction in estimated major osteoporotic fracture risk with DEN (least-squares mean difference −11.20% [95% CI, −20.76% to −1.64%]; P=0.025).

Denosumab demonstrated greater femoral neck BMD improvement and larger reductions in osteocalcin and estimated major osteoporotic fracture risk than zoledronic acid after 1 year in women with T2DM and osteoporosis. Lumbar spine and total hip BMD changes were similar between groups. These findings support DEN as a potential option for patients with low femoral neck BMD within the study population evaluated.