Denosumab and incidence of type 2 diabetes among adults with osteoporosis: population based cohort study. (18th April 2023)

• Record Type: Journal Article
• Authors: Lyu, Houchen; Zhao, Sizheng Steven; Zhang, Licheng; Wei, Jie; Li, Xiaoxiao; Li, Hui; Liu, Yi; Yin, Pengbin; Norvang, Vibeke; Yoshida, Kazuki; Tedeschi, Sara K; Zeng, Chao; Lei, Guanghua; Tang, Peifu; Solomon, Daniel H
• Is Part Of: BMJ. Volume 381(2023)
• Publication Date: 2023-04-18
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj-2022-073435
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract: Objective: To estimate the effect of denosumab compared with oral bisphosphonates on reducing the risk of type 2 diabetes in adults with osteoporosis. Design: Population based study involving emulation of a randomized target trial using electronic health records. Setting: IQVIA Medical Research Data primary care database in the United Kingdom, 1995-2021. Participants: Adults aged 45 years or older who used denosumab or an oral bisphosphonate for osteoporosis. Main outcome measures: The 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. Results: 4301 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). Conclusions: In 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.