The relationship between osteoporosis therapies and metabolic outcomes remains incompletely understood, particularly regarding incident type 2 diabetes mellitus (T2DM). A retrospective cohort study published in Endocrine Practice compared the risk of new-onset T2DM between intravenous (IV) bisphosphonates and denosumab in adults with osteoporosis.
The study used TriNetX database data collected between 2016 and 2024. Adults with osteoporosis initiating IV bisphosphonates, including zoledronic acid or ibandronate, or denosumab were identified and assigned to respective treatment cohorts. Propensity score matching balanced demographic characteristics, lifestyle factors, healthcare utilization, comorbidities, medications, and laboratory parameters. Incident T2DM was defined using ICD-10 coding or initiation of antidiabetic therapy.
Findings
- After propensity score matching, 20,735 participants remained in each treatment cohort.
- Compared with denosumab, IV bisphosphonates demonstrated lower incident T2DM risk at 1, 3, 5, and 7 years of follow-up (all P < 0.001).
- Hazard ratios for T2D ranged from 0.745 at 1 year to 0.821 at 7 years for IV bisphosphonates versus denosumab.
- Subgroup analyses demonstrated consistent findings among women, adults aged at least 65 years, White participants, and Black or African American participants.
The analysis demonstrated lower incident T2DM risk among patients receiving IV bisphosphonates compared with denosumab for osteoporosis treatment. These findings support further prospective evaluation of potential metabolic effects associated with osteoporosis therapies.
