@article{3085905,
    title = "Efficacy of anti-osteoporotic medications in patients with type 1 and 2 diabetes mellitus: a systematic review",
    author = "Anagnostis, P. and Paschou, S.A. and Gkekas, N.N. and Artzouchaltzi, A.-M. and Christou, K. and Stogiannou, D. and Vryonidou, A. and Potoupnis, M. and Goulis, D.G.",
    journal = "Endocrine Development",
    year = "2018",
    volume = "60",
    number = "3",
    pages = "373-383",
    publisher = "Humana Press Inc.",
    doi = "10.1007/s12020-018-1548-x",
    keywords = "alendronic acid;  alkaline phosphatase bone isoenzyme;  anti osteoporotic agent;  biological marker;  hormone;  parathyroid hormone[1-34];  raloxifene;  unclassified drug;  bone density conservation agent, bone density;  bone fragility;  bone turnover;  drug effect;  drug efficacy;  drug response;  fracture;  human;  insulin dependent diabetes mellitus;  non insulin dependent diabetes mellitus;  ossification;  osteoporosis;  priority journal;  Review;  risk factor;  risk reduction;  systematic review;  complication;  drug effect;  insulin dependent diabetes mellitus;  non insulin dependent diabetes mellitus;  osteoporosis, Bone Density;  Bone Density Conservation Agents;  Diabetes Mellitus, Type 1;  Diabetes Mellitus, Type 2;  Humans;  Osteoporosis",
    abstract = "Purpose: Both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) have been associated with bone fragility and increased fracture risk. However, little is known regarding the effect of anti-osteoporotic treatment on bone mineral density (BMD) and/or fracture risk in these patients. We aimed to systematically investigate the efficacy of anti-osteoporotic medications in patients with diabetes in comparison with non-diabetic subjects. Methods: MEDLINE and Scopus databases were searched (up to 31st October 2017). Results: Nine studies fulfilled the pre-defined inclusion criteria [patients with T2DM (n = 8) or either T1DM or T2DM (n = 1)]. Regarding fracture risk, five studies were identified. Alendronate demonstrated comparable vertebral anti-fracture efficacy in patients with and without diabetes (n = 2), whereas non-vertebral fracture risk was either the same (n = 1) or higher in diabetic patients (n = 1). Raloxifene also demonstrated comparable vertebral anti-fracture efficacy in both groups (n = 2), without any effect on non-vertebral fractures in either group. In one study, diabetic patients exposed to raloxifene demonstrated the same vertebral and non-vertebral fracture risk with non-diabetic patients. Teriparatide (n = 1) demonstrated the same non-vertebral fracture rates in both patients with and without T2DM. Regarding BMD, equal increases in spine BMD were observed with alendronate (n = 4), risedronate (n = 1), and teriparatide (n = 1). With respect to hip BMD, similar increases were observed with teriparatide (n = 1), whereas data regarding alendronate were controversial (n = 3). No eligible study was found for zoledronic acid, ibandronate, strontium ranelate, denosumab, or bazedoxifene. Conclusions: The presence of diabetes does not alter anti-osteoporotic treatment response, regarding BMD increase and vertebral fracture risk reduction. © 2018, Springer Science+Business Media, LLC, part of Springer Nature."
}