The use of insulin for the management of type 2 diabetes is associated with rapid loss of bone mineral density at the femoral neck in women transitioning through menopause, according to an observational study published in Osteoporosis International.
In this longitudinal study, investigators compared the associations between insulin use and bone mineral density (BMD) loss in women in premenopause or early perimenopause who had type 2 diabetes. Researchers compared women who did (n=55) vs did not (n=55) require insulin therapy for blood sugar management. Patient characteristics were similar between the 2 groups; however, those using insulin had diabetes twice as long as those not using insulin (9.1 vs 5.7 years, respectively).
At the femoral neck, researchers observed a greater loss of BMD among insulin users vs non-users (-1.1% vs -0.77%, respectively; P =.04).
The researchers observed no differences between the 2 groups with regard to BMD loss at the total hip (-0.31% vs -0.25; P =.71) or the spine (-0.30% vs -0.32%; P =.85). Despite the greater loss of BMD at the femoral neck in insulin users compared with non-insulin users, the researchers found no difference between the 2 groups with regard to fracture risk (hazard ratio 1.4; 95% CI, 0.43-4.3; P =.81).
The observational design of this study presents the potential for imbalances in patient characteristics. These imbalances may have contributed to the differences in BMD loss and prevents the researchers from determining causality. Additionally, the findings of this study are possibly only applicable to women in menopause.
Overall, the results of this study, “suggest that when making treatment decisions for women with diabetes, special consideration should be given to women who are at a high risk for osteoporosis.”
Ruppert K, Cauley J, Lian Y, Zgibor JC, Derby C, Solomon DH. The effect of insulin on bone mineral density among women with type 2 diabetes: a SWAN Pharmacoepidemiology study [published online October 27, 2017]. Osteoporos Int. doi:10.1007/s00198-017-4276-9