Oral bisphosphonates improve the bone mineral density in men with diabetes with or without thiazolidinediones
Subhashini Yaturu, Jared Davis
DOI: 10.4236/jdm.2011.14018   PDF   HTML     4,264 Downloads   7,617 Views  


Objective: Osteoporosis and type 2 diabetes mellitus (DM) two of the most common chronic conditions and represent major public health burdens. Epidemiological and observational studies indicate that thiazolidinedione (TZD) therapy with rosiglitazone and pioglitazone is associated with an increased risk of fractures and decreased bone mineral density (BMD). To our knowledge, no data are available to evaluate bisphosphonate therapy in thiazolidinedione-treated patients. The aim of this study was to investigate the benefit of bisphosphonates to improve changes in BMD in subjects with DM associated with TZDs. Methods: In a cross-sectional observational study using a retrospective review of electronic medical records, the changes in BMD in subjects with type 2 DM. The study subjects were divided into four groups. First group with DM receiving both TZDs and BPs; second group neither; third group receiving only TZDs and the fourth only BPs. The comparison of annual percent changes in BMD between the groups were carried out. Results: Decreased BMD noted in subjects with DM on TZDs. Bisphosphonates improved BMD in subjects with DM on TZDs. BMD improved in subjects with DM in those not receiving TZDs also. Conclusion: We conclude that concomitant treatment with bisphosphonates improves BMD in subjects with diabetes and on TZDs.

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Yaturu, S. and Davis, J. (2011) Oral bisphosphonates improve the bone mineral density in men with diabetes with or without thiazolidinediones. Journal of Diabetes Mellitus, 1, 129-132. doi: 10.4236/jdm.2011.14018.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Strotmeyer, E.S. and Cauley, J.A. (2007) Diabetes mellitus, bone mineral density, and fracture risk. Current Opinion in Endocrinology, Diabetes and Obesity, 14, 429-435. doi:10.1097/MED.0b013e3282f1cba3
[2] Janghorbani, M., et al. (2006) Prospective study of diabetes and risk of hip fracture: The nurses’ health study. Diabetes Care, 29, 1573-1578. doi:10.2337/dc06-0440
[3] Strotmeyer, E.S., et al. (2005) Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: The health, aging, and body composition study. Archives of Internal Medicine, 165, 1612-1617. doi:10.1001/archinte.165.14.1612
[4] Cauley, J.A., et al. (2005) Bone mineral density and the risk of incident nonspinal fractures in black and white women. The Journal of the American Medical Association, 293, 2102-2108. doi:10.1001/jama.293.17.2102
[5] Schwartz, A.V. and Sellmeyer, D.E. (2004) Women, type 2 diabetes, and fracture risk. Current Diabetes Reports, 4, 364-369. doi:10.1007/s11892-004-0039-z
[6] Nicodemus, K.K. and Folsom, A.R. (2001) Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care, 24, 1192-1197. doi:10.2337/diacare.24.7.1192
[7] Wallace, C., et al. (2002) Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabetes Care, 25, 1983-1986. doi:10.2337/diacare.25.11.1983
[8] Schwartz, A.V., et al. (2002) Older women with diabetes have a higher risk of falls: A prospective study. Diabetes Care, 25, 1749-1754. doi:10.2337/diacare.25.10.1749
[9] Keene, G.S., Parker, M.J. and Pryor, G.A. (1993) Mortality and morbidity after hip fractures. British Medical Journal, 307, 1248-1250. doi:10.1136/bmj.307.6914.1248
[10] Haentjens, P., et al. (2001) The economic cost of hip fractures among elderly women. A one-year, prospective, observational cohort study with matched-pair analysis. Belgian Hip Fracture Study Group. The Journal of Bone and Joint Surgery (American Volume), 83-A, 493-500.
[11] Hollingworth, W., et al. (1993) Cost analysis of early discharge after hip fracture. British Medical Journal, 307, 903-906. doi:10.1136/bmj.307.6909.903
[12] Botushanov, N.P. and Orbetzova, M.M. (2009) Bone mineral density and fracture risk in patients with type 1 and type 2 diabetes mellitus. Folia Medica (Plovdiv), 51, 12-17.
[13] Kahn, S.E., et al. (2006) Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. The New England Journal of Medicine, 355, 2427-2443. doi:10.1056/NEJMoa066224
[14] Douglas, I.J., et al. (2009) The risk of fractures associated with thiazolidinediones: A self-controlled case-series study. PLoS Medicine, 6, e1000154. doi:10.1371/journal.pmed.1000154
[15] Jones, S.G., et al. (2009) Distal upper and lower limb fractures associated with thiazolidinedione use. American Journal of Managed Care, 15, 491-496.
[16] Dormuth, C.R., et al. (2009) Thiazolidinediones and fractures in men and women. Archives of Internal Medicine, 169, 1395-1402. doi:10.1001/archinternmed.2009.214
[17] Bodmer, M., et al. (2009) Risk of fractures with glitazones: A critical review of the evidence to date. Drug Safety, 32, 539-547. doi:10.2165/00002018-200932070-00001
[18] Bilik, D., et al. (2010) Thiazolidinediones and fractures: Evidence from translating research into action for diabetes. The Journal of Clinical Endocrinology & Metabolism, 95, 4560-4565.
[19] Glintborg, D., et al. (2008) Association of pioglitazone treatment with decreased bone mineral density in obese premenopausal patients with polycystic ovary syndrome: A randomized, placebo-controlled trial. The Journal of Clinical Endocrinology & Metabolism, 93, 1696-1701. doi:10.1210/jc.2007-2249
[20] Yaturu, S., Bryant, B. and Jain, S.K. (2007) Thiazolidinedione treatment decreases bone mineral density in type 2 diabetic men. Diabetes Care, 30, 1574-1576. doi:10.2337/dc06-2606
[21] Ton, F.N., et al. (2005) Effects of low-dose prednisone on bone metabolism. Journal of Bone and Mineral Research, 20, 464-470. doi:10.1359/JBMR.041125
[22] Vestergaard, P., Rejnmark, L. and Mosekilde, L. (2010) Are antiresorptive drugs effective against fractures in patients with diabetes? Calcified Tissue International, 88, 209-214.
[23] Dagdelen, S., Sener, D. and Bayraktar, M. (2007) Influence of type 2 diabetes mellitus on bone mineral density response to bisphosphonates in late postmenopausal osteoporosis. Advances in Therapy, 24, 1314-1320. doi:10.1007/BF02877778
[24] Lo, J.C., et al. (2006) Persistence with weekly alendronate therapy among postmenopausal women. Osteoporosis International, 17, 922-928. doi:10.1007/s00198-006-0085-2
[25] Cramer, J.A., et al. (2005) Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Current Medical Research & Opinion, 21, 1453-1460. doi:10.1185/030079905X61875
[26] Siris, E.S., et al. (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: Relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clinic Proceedings, 81, 1013-1022. doi:10.4065/81.8.1013
[27] Huybrechts, K.F., Ishak, K.J. and Caro, J.J. (2006) Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone, 38, 922-928. doi:10.1016/j.bone.2005.10.022
[28] Khamaisi, M., et al. (2007) Possible association between diabetes and bisphosphonate-related jaw osteonecrosis. The Journal of Clinical Endocrinology & Metabolism, 92, 1172-1175. doi:10.1210/jc.2006-2036
[29] Pitocco, D., et al. (2005) Six-month treatment with alendronate in acute Charcot neuroarthropathy: A randomized controlled trial. Diabetes Care, 28, 1214-1245. doi:10.2337/diacare.28.5.1214
[30] Ikeda, T., Manabe, H. and Iwata, K. (2004) Clinical significance of alendronate in postmenopausal type 2 diabetes mellitus. Diabetes & Metabolism, 30, 355-358. doi:10.1016/S1262-3636(07)70128-3

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