A drug commonly prescribed to treat osteoporosis may reduce the risk of developing type 2 diabetes by 36%, according to a study conducted at Aalborg University Hospital in Denmark.
The number of people living with diabetes has been steadily increasing, with estimates suggesting 463 million adults worldwide were living with diabetes in 2019, compared to the 1980s when an estimated 108 million people had diabetes. By 2045, estimates suggest 700 million individuals worldwide will be living with diabetes.
There are two types of diabetes. Type 1 usually develops in early childhood and occurs when the body does not produce enough insulin; the hormone that regulates blood sugar levels. Type 1 diabetes requires daily injections of insulin.
Type 2 diabetes is far more common and usually develops in later life. Type 2 diabetes is where the body does not use insulin effectively. The development of type 2 diabetes is strongly linked with lifestyle factors such as obesity and a lack of physical activity.
Diabetes affects glucose homeostasis, the disruption of which has been shown to affect bone homeostasis – the formation of bone by osteoblasts and the destruction of bone by osteoclasts. When out of balance, the bone destruction can result in osteoporosis, where bones become more porous and brittle.
Previous research conducted over the past decade suggests some antidiabetic drugs can affect bone homeostasis while anti-osteoporosis drugs can affect glucose homeostasis. Researchers at Aalborg University Hospital conducted an observational study of the latter on patients that used the osteoporosis medication alendronate to identify its effect on type 2 diabetes risk.
The researchers studied hospital records from the Danish National Patient Registry from 2008 to 2018 and identified patients aged 50 or older who had developed diabetes after 2008, then each of the identified individuals was matched with three randomly selected people who had not developed diabetes. The researchers identified 163,588 people from the Patient Registry who had type 2 diabetes, and there were 490,764 matched individuals in the control group. 45% of the patients were female and the mean patient age was 67 years.
The researchers looked at the prescription records in the Danish National Health Service Prescription Database to identify individuals who used alendronate, then assessed how the drug affected the onset of diabetes.
The researchers determined individuals taking alendronate were 36% less likely to develop diabetes than individuals who did not take the drug. They also determined a dose-dependent effect of the drug. The longer the drug was taken, the lower the risk of developing type 2 diabetes. Individuals who had taken the drug for 8 years or more were 53% less likely to develop type 2 diabetes than individuals who did not take the drug.
One of the authors of the study, Rikke Viggers, MD, suggested alendronate may have a direct action on adipose and muscle tissue, with the effect likely 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,” suggested Viggers.
The study suggests alendronate could have a protective effect against type 2 diabetes, although this was only an observational study, so clinical trials would be needed to confirm any protective effect and further research would be required to determine the mechanism of action, should any mechanism exist. Viggers said, “We are currently performing a clinical trial to investigate if alendronate may actually improve glucose metabolism and insulin sensitivity among people with diabetes.”
The findings of the study were presented at the annual meeting of the European Association for the Study of Diabetes. The paper is currently going through the peer review process.