Patients taking drugs for osteoporosis (bisphosphonates) were less likely to a develop diabetes. Analysis of a database of patient records found that those taking drugs for osteoporosis (bisphosphonates) were less likely to develop diabetes than similar patients not prescribed the drugs.
The research undertaken by University of Birmingham’s health informatics group (“phi”: www.birmingham.ac.uk/phi) working with international collaborators was recently published in the prestigious Journal of Clinical Endocrinology and Metabolism (JCEM).
MPH students may vaguely recall using a sample of the data for their Practical Epidemiology and Statistics module assignment!
The responses to a journalist who quizzed the authors about the study are provided below. We have also included the Abstract of the paper in the newsletter.
1. Were you at all surprised by these findings?
“Yes, we were surprised. When we started this research we thought that bisphosphonates might increase the chances of developing diabetes. That is what evidence from animal studies suggested. In fact we found that patients prescribed bisphosphonates for a long-time had half the chance of developing diabetes”.
2. Would you envision bisphosphonates ever being used to prevent type 2 diabetes?
“It is too much of a jump to suggest that bisphosphonates might be used to prevent diabetes. At this stage we have some evidence that bisphosphonates don’t have harmful effect on glucose homeostasis rather than strong evidence of benefits. The data are observational and therefore the findings should be interpreted cautiously. It is always possible that people prescribed bisphosphonates differ in some subtle way from those not prescribed them and this could cause the differences in rates of developing diabetes. On the other hand it certainly has given us a good reason to further investigate the possible potential positive impact of bisphosphonates on glucose homeostasis”.
3. What main message would you hope for physicians to take away from this report?
“Bisphosphonates play an important role in both primary and secondary fracture prevention among patients with osteoporosis. In an unpublished analysis we conducted, only around 50% of patients with a clinical need for secondary fracture prevention were actually prescribed the medication. Hopefully our study will give physicians more confidence in prescribing for those in need of the medication”.
4. What other points, if any, would you like to make?
“Electronic medical records are a valuable resource for this type of research. Sometimes there is no other practical way of investigating unanticipated effects of prescribed drugs”.
Context: Evidence suggests that the human skeleton might be involved in the regulation of glucose homeostasis.
Objective: The objective of the study was to investigate the effect of exposure to bisphosphonates on the risk of incident type 2 diabetes mellitus (T2DM).
Design: This was a population-based, retrospective, open cohort study over the period 1995–2010.
Setting: The study was conducted from The Health Improvement Network database from the United Kingdom in a primary care setting.
Patients: A total of 35 998 individuals aged older than 60 years, without diabetes at baseline and with more than 1 year’s exposure to bisphosphonates, and 126 459 age-, gender-, body mass index and general practice-matched unexposed individuals participated in the study.
Main Outcome Measure: A new diagnosis of T2DM during the 16-year-long observation period, determined by Read codes and adjusted incidence rate ratio in bisphosphonate-exposed compared with unexposed groups, was the main outcome measure.
Results: The risk of incident T2DM was significantly lower in patients exposed to bisphosphonates compared with matched controls [adjusted incidence rate ratio 0.52, 95% confidence interval (CI) 0.48–0.56, P=0.0001]. In subgroup analyses, the findings remained consistent in males [0.77 (95%CI 0.66–0.89)], females [0.49 (95% CI 0.45–0.53)], obese [0.54 (95% CI 0.50–0.59)], individuals exposed to steroid treatment [0.47 (95% CI 0.34–0.64)], and over different types of bisphosphonate medication. Analysis of duration of treatment suggested a brief increase in the risk of T2DM (1 to 2.5 y of exposure), followed by a progressive, sustained decrease as the years of exposure accumulated.
Conclusions: This observational evidence suggests exposure to bisphosphonates was associated with a significant 50% reduction in the risk of incident T2DM.
To access the article click here: http://press.endocrine.org/doi/10.1210/jc.2014-3481
By Krish Nirantharakumar, Senior Clinical Lecturer and Tom Marshall, Professor of Public Health and Primary Care