Researchers looked into how a common anti-osteoporosis drug called alendronate has the ability to affect patients’ risk of developing diabetes. The study came up with interesting findings. It showed that patients who took alendronate were actually 36 percent less likely to develop type 2 diabetes than those who did not take the drug at all. The researchers also said that more studies and clinical trials are needed to understand why anti-osteoporosis drugs can and may reduce the risk of type 2 diabetes. If studies have been fully conducted, this could one day be used as a preventive measure for diabetes.
All about Diabetes
Diabetes is considered a chronic disease that involves the body’s production and response to insulin. Insulin, on the other hand, is a hormone that regulates the blood sugar. If the blood sugar will remain unmanaged, the damages on nerves and blood vessels, as well as many of the body’s systems, can be devastating. Diabetes comes with a myriad of complications such as cardiovascular disease, kidney disease, neuropathy, blindness, and lower extremity amputation.
Type 1 diabetes typically happens at a young age. This is because the body does not produce enough insulin and hence, requires daily insulin injections. This is also much rarer than type 2 diabetes. The second type happens when the body does not have the ability to utilize insulin efficiently. More importantly, this happens because of lifestyle factors, including excessive body weight and lack of physical activity.
When you look at global statistics, the number of people living with diabetes has definitely and undeniably gone up, from an estimated 108 million people in the 1980s to 476 million in the year 2017. The World Health Organization (WHO), in fact,says that in 2019, 1.5 million deaths worldwide were directly linked to diabetes. As for the scientists and researchers, they are still looking into and exploring the underlying causes and mechanisms of the disease.
Previous research has been made this found that the balancing of blood sugar levels, known as glucose homeostasis, has an impact on the formation of bones, known as bone homeostasis, and vice versa. Studies made have also shown how some antidiabetes drugs may affect the skeleton and how anti-osteoporosis drugs may have an impact on glucose metabolism. So, what exactly is osteoporosis? This is essentially a condition in which bones weaken over time. They are then more likely to break when they become fragile.
It is then crucial to understand the effects that anti-osteoporosis medications have on diabetes. This may help treat and prevent the condition from happening altogether.
In a recent study made, researchers from Aalborg University Hospital, Aalborg, Denmark, conducted an observational study. Their goal was to see how first-line osteoporosis medication, alendronate, affects the risk for type 2 diabetes. “It has been known for decades that people with diabetes are in greater risk of fractures, compared to people without diabetes,” said Rikke Viggers, MD, one of the authors of the study. He talked to Medical News Today about it. He also explained, “In addition, a few studies during the last 10 years have suggested that treatments against osteoporosis may as well impact on glucose metabolism.”
Viggers also said, “These results suggest that alendronate may protect against type 2 diabetes in a dose-dependent manner with a possible effect of higher compliance, but we question the mechanism of action.”
The study Viggers made was presented at the annual meeting of the European Association for the Study of Diabetes. Once the research has been reviewed by peers, this may finally come out in the journal Diabetologia.
Data Analysis
In order to understand the condition even further, the researchers looked into hospital records made between the years 2008 to 2018. These records were from the Danish National Patient Registry. Their goal was to identify patients 50 years and older and who developed diabetes after 2008.
After which, the researchers matched each of these individuals with three randomly selected people that didn’t suffer from diabetes. In total, the researchers looked at records from a total of 163,588 people with type 2 diabetes and 490,764 matched controls. Their mean age was 67 years old, and 45 percent of whom were female.
The researchers also looked into the redeemed prescription records from the Danish National Health Service Prescription Database. Their goal was to calculate whether participants utilized alendronate and how this influenced the onset of their diabetes. With the calculations made, they found that patients who had taken alendronate were 36 percent less likely to be diagnosed with type 2 diabetes than those who did not take the drug at all.
They also found a dose-dependent effect of taking the drug: The longer patients took alendronate, the lower their risk were for being diagnosed with type 2 diabetes. Those taking alendronate for more than 8 years were also 53 percent less likely to develop diabetes when compared to those who did not use it.
Unknown Mechanisms
Dr. Viggers also explained to MNT, “We do not know the mechanism of action and if this even exists — we need more clinical trials. However, it is possible that alendronate impacts directly in peripheral cells, e.g., a direct action on adipose and muscle tissue.”
“It is also likely, that the effect is driven indirectly by the known alteration of bone cells by alendronate. This will change secretion and release of bone metabolites that are potential actors on insulin sensitivity and glucose metabolism,” the doctor further stated.
“Since this is an observational study, the major concern is that people who are prescribed alendronate were a group that is less likely to get diabetes,” said Grenye O’Malley, MD, an assistant professor of diabetes and bone disease at the Icahn School of Medicine at Mount Sinai. The doctor, however, was not involved in the study. Nonetheless, she shared her views with MNT.
“Though the authors report controlling for current BMI, women who have been low weight throughout their lives are more likely to have osteoporosis and less likely to have diabetes. This association could be what is being picked up in this study,” she also said.
“There are some hypotheses also related to vitamin D also having an effect on diabetes. If those studies were to also confirm this, it would give weight to there being a closer link between bone metabolism and diabetes,” she added.
“Another concern is that the difference in diabetes rates was seen in people who took alendronate for over 8 years — since we now often start drug holidays when using alendronate to treat osteoporosis after 5 years, this population may have had more severe osteoporosis,” she elaborated.
The researchers came up with a conclusion. They stated that the results they come up with suggest a possible protective effect of alendronate against type 2 diabetes. Still, they recognize the importance of future clinical research. This, for them, is still very much needed in order to see if the drug actually regulates blood sugar levels.
“This is a register-based study that is merely ‘just’ generating hypotheses, so, these results need to be confirmed in one and more clinical trials before we can talk about a possible causality and potential to impact on current guidelines,” said Dr. Viggers. She further continued, “We are currently performing a clinical trial to investigate if alendronate may actually improve glucose metabolism and insulin sensitivity among people with diabetes.”
“It could be beneficial to include high quality analyses, e.g., insulin clamp, tissue biopsies, and bone markers before and after alendronate treatment to investigate if and where the effect of alendronate is located. If this is the case, alendronate could be beneficial as treatment in patients with osteoporosis and high risk of developing type 2 diabetes,” she added.
The Study’s Strengths and Limitations
“It’s promising that long-term use of alendronate — a cheap and readily available drug that is commonly used to treat osteoporosis — is linked to reduced risk of developing type 2 diabetes,” said Esther Walden. She is a senior clinical advisor at Diabetes UK. She also was not involved in the study, but shared her expert views with MNT.
“In the meantime, this research may help inform clinicians’ decisions, with alendronate potentially offering an added advantage when treating people with bone density issues who may also be at risk of type 2 diabetes,” she added.
“At this point, I would not change management based on this study since it was observational, but it should prompt a lot more research,” shared Dr. O’Malley, “Use of alendronate for long term is likely not the answer to preventing diabetes, but this finding could prompt other research to learn more about bone and diabetes metabolism.”
“This study is an interesting one,” explained Robert Gabbay, MD, Ph.D., chief scientific and medical officer for the American Diabetes Association. He further explained to MNT, “Since it represents looking back at data previously collected (retrospective analysis), one can only create a hypothesis around the possibility that alendronate may be beneficial. We, of course, always like to see the full paper for better analysis and it is difficult to judge based on an abstract.”
“If these results hold true, I suspect there are many other data sets that could be interrogated to see if there is some association between alendronate use and diabetes. The limitation of the study is that it is retrospective. And of course, the full studies have not been published yet, to my knowledge,” he added.
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