Journal Article

Denosumab and incidence of type 2 diabetes among adults with osteoporosis: population based cohort study

Solomon, Daniel H, Zeng, Chao, Li, Xiaoxiao, Zhao, Sizheng Steven, Li, Hui, Norvang, Vibeke, Tang, Peifu, Lei, Guanghua, Tedeschi, Sara K, Wei, Jie, Yoshida, Kazuki, Yin, Pengbin, Liu, Yi, Lyu, Houchen, Zhang, Licheng

2023

Overview

AbstractObjectiveTo estimate the effect of denosumab compared with oral bisphosphonates on reducing the risk of type 2 diabetes in adults with osteoporosis.DesignPopulation based study involving emulation of a randomized target trial using electronic health records.SettingIQVIA Medical Research Data primary care database in the United Kingdom, 1995-2021.ParticipantsAdults aged 45 years or older who used denosumab or an oral bisphosphonate for osteoporosis.Main outcome measuresThe primary outcome was incident type 2 diabetes, as defined by diagnostic codes. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals, comparing denosumab with oral bisphosphonates using an as treated approach.Results4301 new users of denosumab were matched on propensity score to 21 038 users of an oral bisphosphonate and followed for a mean of 2.2 years. The incidence rate of type 2 diabetes in denosumab users was 5.7 (95% confidence interval 4.3 to 7.3) per 1000 person years and in oral bisphosphonate users was 8.3 (7.4 to 9.2) per 1000 person years. Initiation of denosumab was associated with a reduced risk of type 2 diabetes (hazard ratio 0.68, 95% confidence interval 0.52 to 0.89). Participants with prediabetes appeared to benefit more from denosumab compared with an oral bisphosphonate (hazard ratio 0.54, 0.35 to 0.82), as did those with a body mass index ≥30 (0.65, 0.40 to 1.06).ConclusionsIn this population based study, denosumab use was associated with a lower risk of incident type 2 diabetes compared with oral bisphosphonate use in adults with osteoporosis. This study provides evidence at a population level that denosumab may have added benefits for glucose metabolism compared with oral bisphosphonates.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD
• Subject: Aged / Aged, 80 and over / Bisphosphonates / Body mass index / Bone Density Conservation Agents - therapeutic use / Clinical medicine / Clinical trials / Cohort analysis / Cohort Studies / Denosumab - therapeutic use / Diabetes / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 - complications / Diabetes Mellitus, Type 2 - drug therapy / Diabetes Mellitus, Type 2 - epidemiology / Diphosphonates - therapeutic use / Disease / Drug use / Electronic medical records / Female / Fractures / Glucose / Glucose metabolism / Humans / Incidence / Male / Medical research / Metabolism / Middle Aged / Monoclonal antibodies / Osteoporosis / Osteoporosis - complications / Osteoporosis - drug therapy / Osteoporosis - epidemiology / Patient admissions / Population studies / Population-based studies / Prescription drugs / Primary care