| Objective:To observe the effect of bisphosphonates(BPs)on islet function and blood glucose in patients with primary osteoporosis(OP).Methods:A total of 246 female patients with primary osteoporosis(OP)who were treated with BPs for more than 1 year in our outpatient clinic and endocrinology department from January 2016 to January 2022 were selected.They were divided into: normal fasting glucose group,impaired fasting glucose(IFG)group,and type 2 diabetes mellitus(T2DM)group according to fasting plasma glucose(FPG)levels;112 female patients diagnosed with osteopenia [only OP basic therapy(calcium and vitamin D)] who visited the clinic at the same time were selected as the control group,and the changes of islet function,FPG,and fasting insulin(FINS)before and after 1-3 years of treatment with BPs were observed in the above groups.Results:1.Comparison of basic data of each group: There was no significant difference in age,liver and kidney function,ions(Ca,P,Mg,ALT,Cr)between the groups before treatment(P > 0.05).(Table 1)2.Comparison of glucose and bone metabolism indexes of OP patients in normal fasting glucose group before and after 1-3 years of BPs treatment:Glucose metabolism indicators :(1)FPG: Compared with that before treatment,FPG of patients treated with BPs for2 and 3 years decreased,and the differences were statistically significant(P < 0.05);(Table 2)(2)FINS: There was no significant difference in FINS values between the groups before and after BPs treatment(P > 0.05);(Table 2)(3)HOMA-IR: Compared with that before treatment,HOMA-IR decreased in patients treated with BPs for 2 and 3 years,and the differences were statistically significant(P < 0.001,P <0.05);compared with patients treated with BPs for 1 year,HOMA-IR decreased in patients treated with BPs for 2 years,and the differences were statistically significant(P <0.05);(Table 2)(4)HOMA-β: Compared with the group before treatment and 1 year after treatment,the HOMA-β value increased in the group treated with BPs for 2 years,and the difference was statistically significant(P < 0.001);however,the HOMA-β value decreased in the group treated with BPs for 3 years and 2 years,and the difference was statistically significant(P <0.05).(Table 2)(5)After removing the effect of OP basic therapeutic drugs(calcium and vitamin D)on glucose metabolism,there were no significant differences in FPG(Table 5-1),HOMA-IR,and HOMA-β(Table 5-2)before and after BPs treatment(P > 0.05).(Table5-1,2)(Table 2)Bone metabolism indicators: Compared with that before treatment,the bone metabolism indicators(OCN,P1 NP,β-CTX)of patients decreased during 3 years of treatment,and increased during treatment,but still decreased compared with that before treatment,and the differences had statistical significance(P < 0.001).(Table 2)3.Comparison of glucose and bone metabolism indicators before and after 1-3years of BPs treatment in OP patients in the IFG group:Glucose metabolism indicators:(1)FPG: FPG decreased in patients at 1 and 2 years of treatment compared with that before treatment,and the differences were statistically significant(P < 0.001);it did not decrease again at 3 years of treatment compared with 2 years,but still decreased compared with that before treatment and 1 year,and the differences were statistically significant(P < 0.001,P<0.05);(Table3)(2)FINS: There was no significant change in FINS values between 1,2,and 3 years before and after treatment(P > 0.05);(Table3)(3)HOMA-IR: Compared with those before treatment,HOMA-IR decreased in patients at 2 and 3 years of treatment,and the differences were statistically significant(P<0.05,P < 0.001);compared with those at 1 year of treatment,HOMA-IR decreased in patients at 2 and 3 years of treatment,and the differences were statistically significant(P<0.05);(Table3)(4)HOMA-β: After 1 year of treatment,HOMA-β values increased compared with those before treatment,and the difference was statistically significant(P < 0.001);they did not continue to increase after 2 and 3 years of treatment,and decreased after 2 and 3years of treatment compared with 1 year of treatment,and the difference was statistically significant(P <0.05).(Table3)(5)After removing the effect of OP basic therapeutic drugs(Calcium preparation and vitamin D)on glucose metabolism:FPG:Compared with before treatment,FPG decreased in patients treated with BPs for 2 and 3 years,and the difference was statistically significant(P < 0.001);(Table 5-1)HOMA-IR: Compared with those before treatment,HOMA-IR values decreased in patients after 3 years of treatment with BPs,and the difference was statistically significant(P <0.05);(Table 5-2)HOMA-β: Compared with that before treatment,HOMA-β values increased in patients 2 years after treatment,and the difference was statistically significant(P < 0.05),but decreased 3 years after treatment compared with 2 years after treatment and there was no significant difference 3 years after treatment compared with that before treatment(P > 0.05);(Table 5-2)Compared with that before treatment,the bone metabolism indicators(OCN,P1 NP,β-CTX)decreased during 3 years of treatment,and increased during treatment,but still decreased compared with that before treatment,and the differences were statistically significant(P < 0.001).(Table 3)4.Comparison of glucose and bone metabolism parameters before and after 1 year of treatment with BPs in OP patients in the T2 DM group:Indicators of glucose metabolism:After 1 year of BPs use,FPG and HOMA-IR decreased(P < 0.001,P<0.05),and HOMA-β increased(P <0.05).(Table 6-1,2)After removing the effects of hypoglycemic drugs,Ca dose and vitamin D,there were no significant differences in FPG,HOMA-IR,and HOMA-β after 1 year of treatment with BPs(P > 0.05).(Table 6-1,2)Bone metabolism indicators:Compared with those before treatment,all bone metabolism parameters(OCN,P1NP,β-CTX)decreased after 1 year of treatment,and the differences were statistically significant(P < 0.001,P<0.05).(Table 4)5.In the IFG 3-year group with significant changes in glucose metabolism parameters(FPG,HOMA-IR),there was also a significant difference in the decrease of bone metabolism parameters(OCN,P1 NP,β-CTX)after 3 years of BPs treatment compared with the control group(P<0.05,P < 0.001).However,there were no significant correlations between changes in glucose metabolism parameters(FPG,HOMA-IR)and changes in bone metabolism parameters(OCN,P1 NP,β-CTX)at the same time(P > 0.05).(Table 5-3-1 to 5-3-3,Table 5-4)Conclusion:The use of bisphosphonates in patients with osteoporosis during standardized anti-osteoporosis treatment may have a certain impact on glucose metabolism,can reduce FPG,HOMA-IR to a certain extent,and improve insulin resistance,but the impact on HOMA-β still needs further study.At the same time,the use of bisphosphonates decreased bone metabolism parameters(OCN,P1 NP,β-CTX),but this change was not associated with changes in glucose metabolism. |
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