Abstract
Objectives: To assess whether the use of denosumab is associated with a reduced risk of type 2 diabetes, compared to oral bisphosphonates, in individuals with osteoporosis.
Design: Population-based cohort study.
Setting: The IQVIA Medical Research Data United Kingdom primary care database (1995-2021).
Participants: Individuals aged 45 years or older who use denosumab or oral bisphosphonates therapy for osteoporosis.
Main Outcome Measures: Observational data were used to emulate an analysis of a hypothetical trial comparing switching to denosumab with continuing an oral bisphosphonate. The primary outcome was incident type 2 diabetes, defined by diagnostic codes. Cox proportional hazards models were used to estimate the adjusted hazard ratio and 95% confidence intervals, comparing denosumab with oral bisphosphonates in an as-treated approach.
Results: 4301 new users of denosumab were matched to 21038 users of oral bisphosphonate on a propensity score and followed for a mean of 2.2 years. The incidence of type 2 diabetes was 5.7 (95% confidence interval 4.3 to 7.3) per 1000 person years in denosumab users and 8.3 (7.4 to 9.2) per 1000 person years in oral bisphosphonate users (hazard ratio 0.68, 95% confidence interval 0.52 to 0.89). Individuals with prediabetes appeared to benefit more from denosumab compared to an oral bisphosphonate (hazard ratio 0.54, 0.35 to 0.82), as did those with a body mass index over 30 (hazard ratio 0.65, 0.40 to 1.05).
Conclusions: In this population-based study, denosumab use was associated with a lower risk of incident type 2 diabetes compared to an oral bisphosphonate in individuals with osteoporosis. This study provides evidence that denosumab may have additional glucose metabolism benefits compared to oral bisphosphonates.
Design: Population-based cohort study.
Setting: The IQVIA Medical Research Data United Kingdom primary care database (1995-2021).
Participants: Individuals aged 45 years or older who use denosumab or oral bisphosphonates therapy for osteoporosis.
Main Outcome Measures: Observational data were used to emulate an analysis of a hypothetical trial comparing switching to denosumab with continuing an oral bisphosphonate. The primary outcome was incident type 2 diabetes, defined by diagnostic codes. Cox proportional hazards models were used to estimate the adjusted hazard ratio and 95% confidence intervals, comparing denosumab with oral bisphosphonates in an as-treated approach.
Results: 4301 new users of denosumab were matched to 21038 users of oral bisphosphonate on a propensity score and followed for a mean of 2.2 years. The incidence of type 2 diabetes was 5.7 (95% confidence interval 4.3 to 7.3) per 1000 person years in denosumab users and 8.3 (7.4 to 9.2) per 1000 person years in oral bisphosphonate users (hazard ratio 0.68, 95% confidence interval 0.52 to 0.89). Individuals with prediabetes appeared to benefit more from denosumab compared to an oral bisphosphonate (hazard ratio 0.54, 0.35 to 0.82), as did those with a body mass index over 30 (hazard ratio 0.65, 0.40 to 1.05).
Conclusions: In this population-based study, denosumab use was associated with a lower risk of incident type 2 diabetes compared to an oral bisphosphonate in individuals with osteoporosis. This study provides evidence that denosumab may have additional glucose metabolism benefits compared to oral bisphosphonates.
| Original language | English |
|---|---|
| Journal | British Medical Journal |
| Volume | 381 |
| Issue number | e073435 |
| DOIs | |
| Publication status | Published - 18 Apr 2023 |
