The apparent protective effect was particularly marked in patients with prediabetes.

Observational studies suggest that denosumab, a biologic RANK ligand inhibitor used as an antiresorptive agent to treat patients with osteoporosis, might have beneficial effects on glucose metabolism. Researchers used a British primary care database to identify 4300 patients with osteoporosis and without diabetes who started using denosumab (either as a first agent or after switching from a bisphosphonate) between 2010 and 2021. Each denosumab recipient was matched to as many as five similar bisphosphonate recipients, with appropriate adjustment for differences between groups.

During five years of follow up, denosumab users were significantly likely than bisphosphonate users to develop type 2 diabetes (5.7 vs 8.3 per 1000 person­-years). The between­-group difference in incident type 2 diabetes was greater among patients with prediabetes (11.8 vs 22.1 per 1000 person­-years). 

Comment: Observational studies suggest that bisphosphonates might also favourably modify glucose metabolism, and this study suggests that denosumab is more effective than bisphosphonates in this regard. But given the various limitations of observational research, it is probably premature to use these findings as a factor in choosing drug therapies for osteoporosis.

Bruce Soloway, MD, Associate Professor Emeritus of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.

Lyu H, et al. Denosumab and incidence of type 2 diabetes among adults with osteoporosis: population based cohort study. BMJ 2023; 381: e073435.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.