Abstract

To study the risk of developing type 1 (T1D) or type 2 (T2D) diabetes among users of drugs against osteoporosis compared to nonusers. Nationwide cohort study in Denmark with all users of drugs against osteoporosis (n = 103,562) as exposed and three age- and sex-matched nondiabetic control subjects (n = 310,683) randomly selected from the background population. The main outcome variable was an incident diagnosis of diabetes after the baseline date. Among users of alendronate, etidronate, and raloxifene, no change in the risk of T1D was observed. However, the risk of developing T2D was reduced with all three drugs (alendronate: hazard ratio [HR] = 0.71, 95% confidence interval [CI] 0.59-0.85, etidronate: HR = 0.77, 95% CI 0.69-0.86, raloxifene: HR = 0.46, 95% CI 0.25-0.87). For alendronate, a dose-dependent risk reduction was observed (≥1 defined daily dose (DDD) per day: HR = 0.22, 95% CI 0.12-0.41, P for trend <0.01), while this was not the case for etidronate and raloxifene. Antiresorptive drugs do not seem associated with an increased risk of diabetes, but they may perhaps provide a protective effect related to the suppression of bone turnover. However, further studies are needed.