Interim Effects of Zoledronate, Denosumab, or Teriparatide on Bone Microarchitecture in Type 2 Diabetes: A Pilot Trial
Authors' conclusion
Teriparatide demonstrated early improvements in bone microarchitecture in postmenopausal women with T2D while denosumab showed a modest increase in bone stiffness at the distal tibia. Larger, adequately powered studies are needed to clarify the relative effects of anabolic and antiresorptive therapies in this population.
Study context
- Population
- Postmenopausal women with T2D >5 years and high fracture risk (prior fragility fracture and/or T-score < −2.5 [corrected for T2D] with elevated FRAX), single tertiary care center in Indiarandomized 1:1:1:1
- Participants
- 129 women
- Comparison
- Zoledronate vs denosumab vs teriparatide vs standard of care
- Primary endpoint
- Changes in bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) at distal tibia and radius (interim exploratory analysis)
- Follow-up
- 24 weeks
Methodological detailspilot, open-label, blinded-end point (PROBE), single-centre, prespecified 24-week interim exploratory analysis
- Pilot
- Open-label
- Blinded-end point (PROBE)
- Single-centre
- Prespecified 24-week interim exploratory analysis
Primary result
As reported in the abstract
Bone microarchitecture (HR-pQCT)
- Teriparatide significantly improved total and trabecular volumetric BMD (vBMD) (tibia and radius), Tb.N, BV/TV (tibia) and Tb.Th (radius)
- Denosumab improved tibial trabecular vBMD and Tb.N
- Zoledronate improved only tibial total vBMD
- Microfinite element strength parameters unchanged, except a modest increase in tibial stiffness with denosumab
- Interim exploratory analysis
Further findings
Bone turnover markers
- Bone turnover markers (BTMs) decreased with antiresorptives, increased with teriparatide, with an anabolic window by 6 weeks
Original publication
Interim Effects of Zoledronate, Denosumab, or Teriparatide on Bone Microarchitecture in Type 2 Diabetes: A Pilot Trial. J Clin Endocrinol Metab. Published 3 November 2025. doi:10.
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