Efficacy Of Bisphosphonate In The Treatment Of Diabetes Mellitus Complicated With Osteoporosis:a Meta-analysis

Objective: To systematically evaluate the clinical efficacy of bisphosphonates(bisphosphonates,BPs)in the treatment of diabetic osteoporosis(Diabetic Osteoporosis,DOP).Methods:According to the principle of PICOS,the search strategy was established in Pubmed,Embase,Cochrane Library,China Journa full-text Database(China national knowledge internet),Wanfang Database,VIP and Chinese Biomedical Literature Database to search the randomized controlled trial(randomized controlled trail,RCT)of bisphosphonate drugs in the treatment of diabetes mellitus complicated with osteoporosis from the establishment of the database to December 2020.The clinical RCT,extraction data and evaluation quality that met the inclusion and exclusion criteria were retrieved and analyzed by Stata15 software.The ordered classification variables were calculated by ratio(Odds Ratio,OR)and 95% confidence interval(confidence interval,CI),and the continuity variables were calculated by weighted mean difference(weighted mean difference,WMD)or standardized mean difference(standardized mean difference,SMD)and95%CI.Results: A total of 11 articles were included,including 8 for alendronate,2 for zoledronate and 1 for riseophosphate,including11 RCT,993 subjects.Bisphosphonates significantly increased serum Bone alkaline phosphatase(BAP)[MD 2.182,95%CI(1.660,2.704),P<0.05],serum osteocalcin(BGP)[MD1.441,95%CI(0.929,1.954),P<0.05],serum phosphorus level[MD0.043,95%CI(-0.03,0.088),P<0.1].Lower serum tartrate-resistant acid phosphatase-5b(TRAP-5b)[MD-1.018,95% CI(-1.243,0.794),P<0.05].There was no significant difference in serum calcium level between the experiencel group and the control group.In addition,compared with the control group,bisphosphonate treatment significantly increased lumbar bone mineral density in diabetic patients with osteoporosis [MD0.060,95%CI(0.032-0.089),P<0.05)],femoral neck bone mineral density [MD 0.069,95%CI(0.052-0.085),P<0.05)] and Ward’s triangle bone mineral density [MD 0.070,95%CI(0.051-0.090),P<0.05)].In addition,the analysis of 5 literatures about clinical efficacy showed that the clinical efficacy of bisphosphonate treatment was 2.359 times higher than that of the control group,and the difference was statistically significant.Three literatures suggest that the use of bisphosphonates combined with hypoglycemic drugs in patients with diabetic osteoporosis can even improve insulin secretion deficiency and insulin resistance.Conclusion:Bisphosphonate combined with calcitrate D can effectively improve bone pain in different parts of patients with diabetic osteoporosis,inhibit the effect of osteoclasts,and increase the bone mineral density of lumbar vertebrae,femoral neck and Wards triangle.However,the included literatures are all in Chinese,which may cause bias,and more RCT support analysis is needed in order to make a more accurate conclusion on its curative effect.