Effects Of Bisphosphonates On Bone And Glucose Metabolism In Postmenopausal Osteoporosis Patients With Or Without Type 2 Diabetes Mellitus

Objective:We aimed to study the effects of bisphosphonates on bone and glucose metabolism in postmenopausal osteoporosis patients with or without type 2 diabetes mellitus and to provide a clinical basis for the treatment of PMOP with T2 DM by bisphosphonates.Methods:180 postmenopausal women diagnosed with primary osteoporosis from March 2017 to August 2018 in outpatient and inpatient of endocrinology department of our hospital.100 in the group with normal glucose tolerance(group A);80 in the group with T2DM(group B),they all took oral hypoglycemic drugs to control plasma glucose stable.The two groups of AB were divided into two subgroups according to whether using bisphosphonates(group A1A2 and group B1B2).Group A1 and group B1 were treated with bisphosphonates(alendronate or risedronate)combined with calcium tablet and vitamin D,while group A2 and B2 were treated with calcium tablet and vitamin D alone.The age,height,weight and other general information of all patients were recorded.The previous fracture history,menstrual and lifestyle history were inquired.Bone mineral density(BMD)of the lumbar spine(L2-L4,total)and left proximal femur(including Neck,Troch,Ward's triangle)was measured in all patients before treatment.Blood biochemical indexes including calcium(Ca),phosphorus(P),magnesium(Mg),parathyroid hormone(PTH),Bone metabolism indexes including :osteocalcinV(OC),total type I procollagen N-terminal propeptide(tPINP)?-C-terminal telopeptide of type I collagen(?-CTX),25 hydroxyvitamin D3(25(OH)D3)and glucose metabolism indexes including fasting plasma glucose(FPG),fasting insulin(FINS),glycosylated hemoglobin A1c(HbA1c),above all of these were measured in all patients before and 6months after treatment.Body mass index(BMI),homeostasis model insulin resistance index(HOMA-IR)and Beta cell function of the islet(HOMA-?)were calculated according to the formula.During the treatment,the adverse reactions in all patients were followed up.at last,comparing.the changes of bone and glucose metabolism in A1,A2,B1 and B2 groups before and after the treatment.Meanwhile,the adverse reactions in AB groups were compared.Results:1.Comparison of blood biochemical and BMD between and within the groups:there is no significant difference in BMI,Menopausal age,Ca,P,Mg,PTH,BMD of the two groups before treatment.There was no significant difference in the above indicators between A1 and A2,B1 and B2 subgroups before treatment.2.Before treatment,FPG,FINS,HbA1 c and HOMA-IR of group B were significantly higher than that of group A,and HOMA-? was lower than that of group A.Bone metabolism indexes(OC,PINP,?-CTX,25(OH)D3)were all lower than group A.There was no statistically significant difference in glucose metabolism indexes(FPG,FINS,HbA1 c,HOMA-IR,HOMA-?)and bone metabolism indexes(OC,PINP,?-CTX,25(OH)D3)between A1 and A2,B1 and B2.3.Comparison of blood biochemical indexes before and after treatment: in A1,A2,B1 and B2 groups:There was no significant difference in blood Ca,P,Mg,PTH between A1,A2,B1 and B2 wether before or after treatment.4.Comparison of glucose and bone metabolism indexes before and after treatment in A1,A2,B1 and B2 groups.Glucose metabolism indexes: after treatment,the glucose metabolism indexes(FPG,VI FINS,HbA1 c,HOMA-IR,HOMA-?)of A1 and A2 groups were compared with those before treatment,and the differences were not statistically significant.FPG,HbA1 c and HOMA-IR in B1 and B2 groups were lower after treatment than before treatment,and the difference was statistically significant.FPG,HbA1 c and HOMA-IR in group B1 decreased more significantly after treatment than in group B2,with statistically significant differences.Bone metabolism index:after treatment,OC,PINP and-CTX levels in A1 group were all decreased compared with that before treatment,while 25(OH)D3 levels were increased,the difference was statistically significant.After treatment,OC and-CTX levels in group B1 were lower than those before treatment,while 25(OH)D3 levels were increased,and the difference was statistically significant;The difference of OC PINP?-CTX level in A2B2 group was not statistically significant between before and after treatment,while the difference of 25(OH)D3 level was statistically significant.5.Comparison of adverse reactions between groups and within groups: During the treatment,5 patients in group A1 had mild gastrointestinal reaction after oral administration of alendronate;and 1 patient had transient flu symptoms during the infusion of isodium ibandronate;In group A2,2 cases had constipation after oral calcium;In group B1,3 patients had mild gastrointestinal reaction after oral administration of alendronate,and 2 patients had transient flu symptoms during infusion of sodium ibandronate.However,none of them withdrew from the study due to adverse drug reactions Conclusion:1.The bone metabolism index of patients with PMOP combined with T2 DM was lower than that of patients with simple PMOP,suggesting that diabetes may have a certain inhibitory effect on the bone conversion index of patients with PMOP.2.Bisphosphonate treatment of PMOP with or without T2 DM can reduce bone turnover without adverse effects on glucose metabolism,and may even decrease FPG,HbA1 c and improve insulin resistance in T2 DM patients.3.There were no serious adverse reactions during the treatment of PMOP with T2 DM,and the safety was acceptable.