title: The use of alendronate is associated with a decreased incidence of type 2 diabetes mellitus--a population-based cohort study in Taiwan.
abstract: OBJECTIVE
  Bone remodeling has been linked to glucose metabolism in animal studies, but the results of human trials were inconclusive. Bisphosphonates may play a role in glucose metabolism through their impacts on bone remodeling enzymes. In this study, we aimed to examine the influence of alendronate usage on the incidence of type 2 diabetes mellitus (DM) among osteoporotic patients.
  
  
  METHODS
  A retrospective cohort study was designed to include osteoporotic patients without DM from a population-based cohort containing 1,000,000 subjects. Patients treated with alendronate (exposed group, N=1,011) were compared with those who received no treatment (age and gender matched non-exposed group, N=3,033). Newly diagnosed DM was identified from medical records by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9CM) code. The incidence of DM in both groups was calculated for comparison.
  
  
  RESULTS
  The non-exposed group had a significantly higher incidence of DM (Odds ratio 1.21, 95% confidence interval 1.03~1.41) when compared with the exposed group. In subgroup analysis, the DM risk reduction in exposed group was only significant among those younger than 65 years and those without hypertension or dyslipidemia. Patients who were prescribed alendronate more than or equal to 3 times had demonstrated a significant reduction in DM risk.
  
  
  CONCLUSIONS
  Our study showed alendronate might yield a protective effect for incident DM. This effect became insignificant in patients with older age, dyslipidemia or hypertension. The underlying mechanism needs further exploration with prospective data for confirmation of the observed findings.
authors: Department of Gerontology and Geriatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Superintendent Office, National Taiwan University Hospital JinShan Branch, New Taipei City, Taiwan.
authors: Ding-Cheng
authors: DC
authors: Chan
authors: Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan.
authors: Rong-Sen
authors: RS
authors: Yang
authors: Institute of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
authors: Chung-Han
authors: CH
authors: Ho
authors: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Yau-Sheng
authors: YS
authors: Tsai
authors: Institute of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
authors: Jhi-Joung
authors: JJ
authors: Wang
authors: Department of Geriatrics, Chi Mei Medical Center, Tainan, Taiwan; Department of Family Medicine, Chi Mei Medical Center, Tainan, Taiwan.
authors: Kang-Ting
authors: KT
authors: Tsai
mesh_terms: D019386:Alendronate / Q000627:therapeutic use*; D015992:Body Mass Index; D016723:Bone Remodeling / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000188:drug therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D019386:Alendronate