Metformin treatment is associated with an increase in bone mineral density in type 2 diabetes mellitus patients in China: A retrospective single center study

Aims: To investigate the association between metformin and bone mineral density (BMD) in a large cohort of Chinese patients with type 2 diabetes mellitus (T2DM). Methods: A total of 11,458 T2DM patients aged & GE;40 years were included. Information on demographic, anthropometric and clinical characteristics was collected from medical records. BMD at lumbar spine (LS), femoral neck (FN), and total hip(TH) was assessed by dual-energy X-ray absorptiometry. Results: Overall prevalence of osteopenia and osteoporosis was 37.4% and 10.3%, and was lower in patients on metformin (34.6% vs 38.3% and 7.1% vs 11.3%, both p < 0.001). Patients who had a lower BMI, older age, and lower estimated glomerular filtration rate (eGFR), had more osteoporosis, lower BMD (osteoporosis or osteo-penia), and a lower T-score at LS, FN and TH. Metformin use and male sex was associated with a higher BMD. Metformin treatment was also independently associated with higher T-score at LS, FN and TH (b values of 0.120, 0.082 and 0.108; all p < 0.001), and lower odds ratio of osteoporosis (OR = 0.779, 95%CI: 0.648-0.937, p = 0.008) or low BMD (OR = 0.834, 95%CI: 0.752 -0.925, p = 0.001). However, when analyzed by sex, this association of a lower odds ratio for osteoporosis with metformin was only significant in women (OR= 0.775, 95% CI: 0.633-0.948; p = 0.013). Conclusions: Metformin treatment was associated with a higher T-score and a lower odds ratio of osteopenia and osteoporosis, especially in the female population, independent of age, BMI, and eGFR.(c) 2022 Elsevier Masson SAS. All rights reserved.

Automated summary

This study investigated the association between metformin and bone mineral density (BMD) in Chinese patients with type 2 diabetes mellitus (T2DM). The results showed that metformin use was associated with a lower prevalence of osteoporosis and osteopenia, especially in women. Metformin treatment was independently associated with higher BMD and a lower odds ratio of osteoporosis and low BMD.