Mazziotti G, Maffezzoni F, Doga M, Hofbauer L C, Adler R A, Giustina A
Department of Clinical and Experimental Sciences, University of Brescia, Italy.
Division of Endocrinology, Diabetes, and Bone Diseases, Dresden University Medical Center, Dresden, Germany.
Bone. 2014 Oct;67:175-80. doi: 10.1016/j.bone.2014.07.008. Epub 2014 Jul 10.
Over the last few years, there has been experimental evidence for the existence of cross-talking between bone remodeling and glucose metabolism. Whether this experimental model can be translated to humans is still debated, and it is also unclear whether the modulation of bone turnover by anti-osteoporotic drugs may lead to changes in glucose metabolism. The aim of this 12-month prospective study was to investigate whether treatment of glucocorticoid-induced osteoporosis (GIO) with bipshosphonates or teriparatide may influence serum glycated hemoglobin (HbA1c) and fasting plasma glucose. One-hundred-eleven patients (70 F, 41 M, median age 70, range: 55-89) chronically treated with glucocorticoids were evaluated for changes in serum HbA1c and fasting plasma glucose during treatment with bisphosphonates (45 cases) or teriparatide (33 cases) as compared to those occurring during treatment with calcium and vitamin D alone (33 cases). In patients treated with teriparatide, but not in those treated with bisphosphonates or calcium and vitamin D alone, a statistically significant (p=0.01) decrease in serum HbA1c was observed during the follow-up, the change being greater (p=0.01) in patients with diabetes as compared to those without diabetes. In most cases, the decrease of serum HbA1c was relatively limited and in some patients the improvement of glucose homeostasis was concomitant with implementation of anti-diabetic treatments. Fasting plasma glucose did not change significantly during either bisphosphonates or teriparatide treatments. In conclusion, currently used bone active drugs may produce limited effects on glucose metabolism in patients with GIO. Interestingly, the bone anabolic drug teriparatide was shown to be associated with some improvement in serum HbA1c in this clinical context.
在过去几年中，已有实验证据表明骨重塑与葡萄糖代谢之间存在相互作用。这种实验模型是否能应用于人类仍存在争议，而且抗骨质疏松药物对骨转换的调节是否会导致葡萄糖代谢的变化也尚不清楚。这项为期12个月的前瞻性研究旨在探讨用双膦酸盐或特立帕肽治疗糖皮质激素诱导的骨质疏松症（GIO）是否会影响血清糖化血红蛋白（HbA1c）和空腹血糖。对111例长期接受糖皮质激素治疗的患者（70例女性，41例男性，中位年龄70岁，范围：55 - 89岁）进行了评估，比较了使用双膦酸盐（45例）或特立帕肽（33例）治疗期间与单独使用钙和维生素D治疗（33例）期间血清HbA1c和空腹血糖的变化。在接受特立帕肽治疗的患者中，而非单独接受双膦酸盐或钙和维生素D治疗的患者中，随访期间观察到血清HbA1c有统计学意义的降低（p = 0.01），与非糖尿病患者相比，糖尿病患者的变化更大（p = 0.01）。在大多数情况下，血清HbA1c的降低相对有限，并且在一些患者中，葡萄糖稳态的改善与抗糖尿病治疗的实施同时出现。在双膦酸盐或特立帕肽治疗期间，空腹血糖均未发生显著变化。总之，目前使用的骨活性药物可能对GIO患者的葡萄糖代谢产生有限影响。有趣的是，在这种临床情况下，骨合成代谢药物特立帕肽被证明与血清HbA1c的一些改善有关。
