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The burden of noncommunicable diseases such as diabetes (type 2 diabetes
mellitus [T2DM]) and osteoporosis is increasing with increasing longevity. Uncontrolled T2DM is an
independent risk factor for osteoporosis explained by the insulin osteocalcin pathway. Due to limited
information on the effect of various commonly used antidiabetic agents (ADA) on bone health, our study
aims to analyze the association between the two.
Methodology: This is a case.control study, with 100 cases of clinical osteoporosis and 100 age., sex., and
dietary status.matched controls in whom osteoporosis was ruled out by dual.energy X.ray absorptiometry
scan. Prescription details of T2DM, physical activity levels, and disease status were collected using a pretested
questionnaire. Exposure to each ADA was compared using the Chi.squared test. Binary logistic regression
was performed to adjust the two main confounders, namely glycemic control and physical activity levels,
and adjusted risk estimates were calculated.
Results: There were a total of 74 T2DM patients, of whom 45 (60.8%) were cases and 29 (39.2%) were controls.
Sulfonylureas (adjusted odds ratio [aOR] = 0.164, P = 0.004) and insulin (aOR = 0.248, P = 0.042) showed
a significant protective effect on bone health. Biguanides (OR = 1.994, P = 0.029) and thiazolidinediones
(OR: 5.444, P = 0.033), which demonstrated that an increased risk of osteoporosis in univariate analysis
became insignificant after multivariate analysis.
Conclusion: Sulfonylureas and insulin through the insulin osteocalcin pathway show favorable effect on
bone health, but the probability of increased fractures secondary to hypoglycemic falls should be borne in
mind. We recommend larger prospective studies to confirm this association.
Keywords: Antidiabetic drugs, bone health, insulin, oral hypoglycemic agents, osteoporosis