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However, it is unclear whether current osteoporosis treatments reduce fractures in individuals with diabetes. The aim of the study was to determine whether presence of T2D influences the efficacy of antiresorptive treatment for osteoporosis using the Foundation for the National Institutes of Health\u00a0(FNIH)\u2013American Society for Bone and Mineral Research (ASBMR)\u2013Study to Advance Bone Mineral Density (BMD) as a Regulatory Endpoint (SABRE) cohort, which includes individual patient data from randomized trials of osteoporosis therapies. In this study we included 96,385 subjects, 6.8% of whom had T2D, from nine bisphosphonate trials, two selective estrogen receptor modulator (SERM) trials, two trials of menopausal hormone therapy, one denosumab trial, and one odanacatib trial. We used Cox regression to obtain the treatment hazard ratio (HR) for incident nonvertebral, hip, and all fractures and logistic regression to obtain the treatment odds ratio (OR) for incident morphometric vertebral fractures, separately for T2D and non-DM. We used linear regression to estimate the effect of treatment on 2-year change in BMD (n\u00a0=\u200949,099) and 3-month to 12-month change in bone turnover markers (n\u00a0=\u200912,701) by diabetes status. In all analyses, we assessed the interaction between treatment and diabetes status. In pooled analyses of all 15 trials, we found that diabetes did not impact treatment efficacy, with similar reductions in vertebral, nonvertebral, all, and hip fractures, increases in total hip and femoral neck BMD, and reductions in serum C-terminal cross-linking telopeptide (CTX), urinary N-telopeptide of type I collagen\/creatinine (NTX\/Cr) and procollagen type 1 N propeptide (P1NP) (all interactions p\u00a0&amp;gt;\u20090.05). We found similar results for the pooled analysis of bisphosphonate trials. However, when we considered trials individually, we found a few interactions within individual studies between diabetes status and the effects of denosumab and odanacatib on fracture risk, change in BMD or bone turnover markers (BTMs). In sum, these results provide strong evidence that bisphosphonates and most licensed antiresorptive drugs are effective at reducing fracture risk and increasing BMD irrespective of diabetes status. \u00a9 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4697","type":"journal-article","created":{"date-parts":[[2022,9,6]],"date-time":"2022-09-06T03:12:20Z","timestamp":1662433940000},"page":"2121-2131","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Diabetes Mellitus and the Benefit of Antiresorptive Therapy on Fracture Risk"],"prefix":"10.1093","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0323-3366","authenticated-orcid":false,"given":"Richard","family":"Eastell","sequence":"first","affiliation":[{"name":"Department of Oncology and Metabolism University of Sheffield Sheffield 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V.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Biostatistics University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas C.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California, San Francisco San Francisco CA USA"},{"name":"Department of Epidemiology & Biostatistics University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5318-7575","authenticated-orcid":false,"given":"Dennis M.","family":"Black","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Biostatistics University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7027-7414","authenticated-orcid":false,"given":"Mary L.","family":"Bouxsein","sequence":"additional","affiliation":[{"name":"Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Department of Orthopedic Surgery Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,9,6]]},"reference":[{"key":"2024012714072734100_jbmr4697-bib-0001","doi-asserted-by":"crossref","first-page":"115457","DOI":"10.1016\/j.bone.2020.115457","article-title":"The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: a systematic review and meta-analysis update","volume":"137","author":"Vilaca","year":"2020","journal-title":"Bone"},{"issue":"4","key":"2024012714072734100_jbmr4697-bib-0002","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s00198-006-0253-4","article-title":"Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes\u2014a 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