{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:06:57Z","timestamp":1791490017012,"version":"4.3.4"},"reference-count":42,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"name":"The Endocrine Society of Tamilnadu","award":["(www.estn.co.in) 27-02-2023"],"award-info":[{"award-number":["(www.estn.co.in) 27-02-2023"]}]},{"DOI":"10.13039\/501100009530","name":"Jawaharlal Institute Of Postgraduate Medical Education and Research","doi-asserted-by":"crossref","award":["JIP\/Res\/Intramural\/Phs 3\/2022\u20132023"],"award-info":[{"award-number":["JIP\/Res\/Intramural\/Phs 3\/2022\u20132023"]}],"id":[{"id":"10.13039\/501100009530","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Zoledronate is most effective when bone turnover is elevated, as in\n                    postmenopausal women. Individuals with type 2 diabetes mellitus show lesser bone\n                    mineral density gains compared to non-diabetes mellitus individuals with\n                    zoledronate, and fractures often occur despite preserved bone mineral density.\n                    It is unclear whether zoledronate reduces fracture risks in type 2 diabetes\n                    mellitus. This study aimed to evaluate skeletal outcomes, including fracture\n                    incidence, over 5 years in postmenopausal osteoporotic women with and without\n                    type 2 diabetes mellitus. This prospective cohort included postmenopausal women\n                    with bone mineral density T-scores of\u2264\u20132.5 at the lumbar spine, femoral\n                    neck, or hip. Participants were classified as type 2 diabetes mellitus or\n                    non-diabetes mellitus. All received annual zoledronate (4 mg), daily calcium\n                    (1000 mg), and cholecalciferol (500 IU), with standardized fall-prevention\n                    measures. Fracture history was recorded at follow-up visits, and annual spine\n                    radiographs were performed to detect morphometric vertebral fractures. Women\n                    completing\u22655 years of follow up were included in the final analysis. The primary\n                    end point was fracture incidence; secondary end points were changes in bone\n                    mineral density and bone turnover markers. Of 221 women enrolled, 150 completed\n                    5 years (63 type 2 diabetes mellitus and 87 non-diabetic mellitus; median age 59\n                    y). The baseline bone mineral density was similar, but bone turnover markers\n                    were lower in type 2 diabetes mellitus. At a minimum of 60 months follow up, 20\n                    new fractures occurred in 15 women: 8 (12.7%) with type 2 diabetes mellitus and\n                    7 (8.0%) without. The relative risk (RR) was 1.58 (95% confidence interval:\n                    0.60\u20134.13; p=0.2). Both groups showed comparable bone mineral density\n                    improvements. Despite differences in baseline bone turnover, fracture incidence\n                    did not differ significantly between postmenopausal women with and without type\n                    2 diabetes mellitus treated with annual zoledronate over a 5-year follow-up.\n                    However, the low number of fracture events and wide confidence intervals limit\n                    definitive inference.<\/jats:p>","DOI":"10.1055\/a-2812-1745","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T23:49:54Z","timestamp":1772668194000},"page":"103-113","source":"Crossref","is-referenced-by-count":2,"title":["Five-Year Fracture Outcomes with Zoledronate in Postmenopausal\n                    Osteoporotic Women with and without Diabetes"],"prefix":"10.1055","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3464-7860","authenticated-orcid":false,"given":"Somdatta","family":"Giri","sequence":"additional","affiliation":[{"name":"Endocrinology, Jawaharlal Institute of Postgraduate\n                    Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Govindarajalou","family":"Ramkumar","sequence":"additional","affiliation":[{"name":"Radio Diagnosis, Jawaharlal Institute of Postgraduate\n                    Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayaprakash","family":"Sahoo","sequence":"additional","affiliation":[{"name":"Endocrinology, Jawaharlal Institute of Postgraduate\n                    Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadishkumar","family":"Kamalanathan","sequence":"additional","affiliation":[{"name":"Endocrinology, Jawaharlal Institute of Postgraduate\n                    Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4568-877X","authenticated-orcid":false,"given":"Dukhabandhu","family":"Naik","sequence":"additional","affiliation":[{"name":"Endocrinology, Jawaharlal Institute of Postgraduate\n                    Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagili Vijaya Bhaskar","family":"Reddy","sequence":"additional","affiliation":[{"name":"Endocrinology, Vijay Diabetes, Thyroid and Endocrine Clinic,\n                    Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandhana","family":"Merugu","sequence":"additional","affiliation":[{"name":"Endocrinology, Jawaharlal Institute of Postgraduate\n                    Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsh","family":"Durgia","sequence":"additional","affiliation":[{"name":"Endocrinology, Jawaharlal Institute of Postgraduate\n                    Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunthoju","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"Endocrinology, Jawaharlal Institute of Postgraduate\n                    Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun","family":"Suryadevara","sequence":"additional","affiliation":[{"name":"Endocrinology, Jawaharlal Institute of Postgraduate\n                    Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samim Ali","family":"Mondal","sequence":"additional","affiliation":[{"name":"Endocrinology, Jawaharlal Institute of Postgraduate\n                    Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"841","DOI":"10.2147\/IJWH.S54623","article-title":"Epidemiology and treatment of osteoporosis in women: an Indian perspective","volume":"7","author":"A V Khadilkar","year":"2015","journal-title":"Int J Womens Health"},{"issue":"07","key":"ref3","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.2337\/diacare.27.7.1547","article-title":"Effect of alendronate on bone mineral density and biochemical markers of bone\n                    turnover in type 2 diabetic women: the fracture intervention trial","volume":"27","author":"TH M Keegan","year":"2004","journal-title":"Diabetes Care"},{"issue":"06","key":"ref4","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1007\/BF02877778","article-title":"Influence of type 2 diabetes mellitus on bone mineral density response to\n                    bisphosphonates in late postmenopausal osteoporosis","volume":"24","author":"S Dagdelen","year":"2007","journal-title":"Adv Ther"},{"key":"ref5","first-page":"257","article-title":"Bisphosphonates\u2014a good choice for women with type 2 diabetes and postmenopausal\n                    osteoporosis?","volume":"64","author":"R Nan","year":"2016","journal-title":"Farmacia"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1007\/s00223-015-0071-9","article-title":"Efficacy and safety of risedronate in osteoporosis subjects with comorbid\n                    diabetes, hypertension, and\/or dyslipidemia: a post hoc analysis of phase III\n                    trials conducted in Japan","volume":"98","author":"D Inoue","year":"2016","journal-title":"Calcif Tissue Int"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"72","DOI":"10.3389\/fendo.2013.00072","article-title":"Bone quality in diabetes","volume":"4","author":"M Saito","year":"2013","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1590472","DOI":"10.3389\/fendo.2025.1590472","article-title":"Zoledronic acid and denosumab are associated with similar fracture incidence and\n                    mortality in patients with type 2 diabetes: a population-based cohort study","volume":"16","author":"V Rouach","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"03","key":"ref9","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1007\/s00223-010-9450-4.","article-title":"Are antiresorptive drugs effective against fractures in patients with\n                    diabetes?","volume":"88","author":"P Vestergaard","year":"2011","journal-title":"Calcif Tissue Int"},{"issue":"01","key":"ref10","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1007\/s00198-012-2184-6","article-title":"Characteristics of patients who suffer major osteoporotic fractures despite\n                    adhering to alendronate treatment: A national prescription registry study","volume":"24","author":"B Abrahamsen","year":"2013","journal-title":"Osteoporos Int"},{"issue":"9041","key":"ref11","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1016\/s0140-6736(96)07088-2","article-title":"Randomised trial of effect of alendronate on risk of fracture in women with\n                    existing vertebral fractures. Fracture Intervention Trial Research Group","volume":"348","author":"D M Black","year":"1996","journal-title":"Lancet"},{"issue":"02","key":"ref12","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1210\/jc.2002-020400","article-title":"Risedronate prevents new vertebral fractures in postmenopausal women at high\n                    risk","volume":"88","author":"N B Watts","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"issue":"05","key":"ref13","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/s8756-3282(99)00202-1","article-title":"Association of prevalent vertebral fractures, bone density, and alendronate\n                    treatment with incident vertebral fractures: effect of number and spinal\n                    location of fractures. The fracture intervention trial research group","volume":"25","author":"M C Nevitt","year":"1999","journal-title":"Bone"},{"issue":"08","key":"ref14","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1359\/JBMR.040325","article-title":"Effects of oral ibandronate administered daily or intermittently on fracture\n                    risk in postmenopausal osteoporosis","volume":"19","author":"C H Chesnut","year":"2004","journal-title":"J Bone Miner Res."},{"issue":"01","key":"ref15","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s001980050010","article-title":"Randomized trial of the effects of risedronate on vertebral fractures in women\n                    with established postmenopausal osteoporosis. Vertebral efficacy with\n                    risedronate therapy (VERT) study group","volume":"11","author":"J Reginster","year":"2000","journal-title":"Osteoporos Int"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"115268","DOI":"10.1016\/j.bone.2020.115268","article-title":"Denosumab in postmenopausal women with osteoporosis and diabetes: Subgroup\n                    analysis of FREEDOM and FREEDOM extension","volume":"134","author":"S Ferrari","year":"2020","journal-title":"Bone"},{"issue":"09","key":"ref17","doi-asserted-by":"publisher","first-page":"3215","DOI":"10.1210\/jc.2008-2765","article-title":"Effect of once-yearly zoledronic acid five milligrams on fracture risk and\n                    change in femoral neck bone mineral density","volume":"94","author":"R Eastell","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa074941","article-title":"Zoledronic acid in reducing clinical fracture and mortality after hip\n                    fracture","volume":"357","author":"K W Lyles","year":"2007","journal-title":"N Engl J Med"},{"issue":"02","key":"ref19","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1210\/jc.2015-2175","article-title":"Global Consensus Recommendations on Prevention and Management of Nutritional\n                    Rickets","volume":"101","author":"C F Munns","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.2337\/dc24-S002","article-title":"2. Diagnosis and classification of diabetes: Standards of care in\n                    diabetes\u20142024","volume":"47","author":"American Diabetes Association Professional Practice\n                            Committee","year":"2024","journal-title":"Diabetes Care"},{"issue":"09","key":"ref21","doi-asserted-by":"publisher","first-page":"2541","DOI":"10.1007\/s00198-017-4082-4","article-title":"National bone health alliance bone turnover marker project. Use of CTX-I and\n                    PINP as bone turnover markers: National bone health alliance recommendations to\n                    standardize sample handling and patient preparation to reduce pre-analytical\n                    variability","volume":"28","author":"P Szulc","year":"2017","journal-title":"Osteoporos Int"},{"issue":"09","key":"ref22","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1002\/jbmr.5650080915","article-title":"Vertebral fracture assessment using a semiquantitative technique","volume":"8","author":"H K Genant","year":"1993","journal-title":"J Bone Miner Res"},{"issue":"03","key":"ref23","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.jocd.2015.06.013","article-title":"Executive summary of the 2015 ISCD position development conference on advanced\n                    measures from DXA and QCT: Fracture prediction beyond BMD","volume":"18","author":"J A Shepherd","year":"2015","journal-title":"J Clin Densitom"},{"issue":"05","key":"ref26","doi-asserted-by":"publisher","first-page":"419","DOI":"10.3109\/13697137.2010.507886","article-title":"Age of menopause and impact of climacteric symptoms by geographical region","volume":"13","author":"S Palacios","year":"2010","journal-title":"Climacteric"},{"issue":"06","key":"ref27","doi-asserted-by":"publisher","first-page":"1697","DOI":"10.1007\/s00198-014-2676-7","article-title":"Biochemical markers of bone turnover in diabetes patients--a meta-analysis, and\n                    a methodological study on the effects of glucose on bone markers","volume":"25","author":"J Starup-Linde","year":"2014","journal-title":"Osteoporos Int"},{"issue":"03","key":"ref28","doi-asserted-by":"publisher","first-page":"R137","DOI":"10.1530\/EJE-16-0652","article-title":"Mechanisms in endocrinology: Diabetes mellitus, a state of low bone turnover\u2014a\n                    systematic review and meta-analysis","volume":"176","author":"K Hygum","year":"2017","journal-title":"Eur J Endocrinol"},{"issue":"25","key":"ref29","doi-asserted-by":"publisher","first-page":"2407","DOI":"10.1056\/NEJMoa1808082","article-title":"Fracture prevention with zoledronate in older women with osteopenia","volume":"379","author":"I R Reid","year":"2018","journal-title":"N Engl J Med"},{"issue":"03","key":"ref30","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1007\/s12020-018-1548-x","article-title":"Efficacy of anti-osteoporotic medications in patients with type 1 and 2 diabetes\n                    mellitus: A systematic review","volume":"60","author":"P Anagnostis","year":"2018","journal-title":"Endocrine"},{"issue":"11","key":"ref31","doi-asserted-by":"publisher","first-page":"2121","DOI":"10.1002\/jbmr.4697","article-title":"Diabetes mellitus and the benefit of antiresorptive therapy on fracture\n                    risk","volume":"37","author":"R Eastell","year":"2022","journal-title":"J Bone Miner Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1186\/s12902-022-01010-w","article-title":"Efficacy of bisphosphonate therapy on postmenopausal osteoporotic women with and\n                    without diabetes: A prospective trial","volume":"22","author":"J Kim","year":"2022","journal-title":"BMC Endocr Disord"},{"issue":"08","key":"ref33","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.1007\/s00198-021-05855-0","article-title":"Do proximal hip geometry, trabecular microarchitecture, and prevalent vertebral\n                    fractures differ in postmenopausal women with type 2 diabetes mellitus? A\n                    cross-sectional study from a teaching hospital in southern India","volume":"32","author":"J Paul","year":"2021","journal-title":"Osteoporos Int"},{"issue":"10","key":"ref34","doi-asserted-by":"publisher","first-page":"e923","DOI":"10.1210\/clinem\/dgad255","article-title":"Biochemical markers of bone fragility in patients with diabetes. A narrative\n                    review by the IOF and the ECTS","volume":"108","author":"C Meier","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"issue":"04","key":"ref35","doi-asserted-by":"publisher","first-page":"1991","DOI":"10.1210\/jc.2009-2283","article-title":"Serum sclerostin levels negatively correlate with parathyroid hormone levels and\n                    free estrogen index in postmenopausal women","volume":"95","author":"F S Mirza","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"03","key":"ref36","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1016\/j.bone.2011.11.028","article-title":"Bisphosphonate treatment of postmenopausal osteoporosis is associated with a\n                    dose dependent increase in serum sclerostin","volume":"50","author":"D Gatti","year":"2012","journal-title":"Bone"},{"issue":"52","key":"ref37","doi-asserted-by":"publisher","first-page":"20764","DOI":"10.1073\/pnas.0805133106","article-title":"Regulation of bone formation by osteoclasts involves Wnt\/BMP signaling and the\n                    chemokine sphingosine-1-phosphate","volume":"105","author":"L Pederson","year":"2008","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"03","key":"ref38","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1111\/cen.14501","article-title":"Characteristics of bone metabolism in postmenopausal women with newly diagnosed\n                    type 2 diabetes mellitus","volume":"95","author":"H Li","year":"2021","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"01","key":"ref39","doi-asserted-by":"publisher","first-page":"173","DOI":"10.3892\/ijmm.2015.2412","article-title":"Uncarboxylated osteocalcin inhibits high glucose-induced ROS production and\n                    stimulates osteoblastic differentiation by preventing the activation of PI3K\/Akt\n                    in MC3T3-E1 cells","volume":"37","author":"J Liu","year":"2016","journal-title":"Int J Mol Med"},{"issue":"02","key":"ref40","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1002\/jcb.20842","article-title":"Chronic hyperglycemia modulates osteoblast gene expression through osmotic and\n                    non-osmotic pathways","volume":"99","author":"S Botolin","year":"2006","journal-title":"J Cell Biochem"},{"issue":"09","key":"ref41","doi-asserted-by":"publisher","first-page":"4380","DOI":"10.1210\/jc.2010-0597","article-title":"Characterization of and risk factors for the acute-phase response after\n                    zoledronic acid","volume":"95","author":"I R Reid","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"3\/4","key":"ref42","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1111\/j.1574-695X.1999.tb01397.x","article-title":"Immune dysfunction in patients with diabetes mellitus (DM)","volume":"26","author":"S E Geerlings","year":"1999","journal-title":"FEMS Immunol Med Microbiol"},{"issue":"01","key":"ref43","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/s11657-020-0688-9","article-title":"Vertebral fracture assessment by dual-energy X-ray absorptiometry along with\n                    bone mineral density in the evaluation of postmenopausal osteoporosis","volume":"15","author":"S Shetty","year":"2020","journal-title":"Arch Osteoporos"},{"issue":"12","key":"ref44","doi-asserted-by":"publisher","first-page":"2013","DOI":"10.1007\/s00198-023-06908-2","article-title":"Effect of SGLT2 inhibitors on fractures, BMD, and bone metabolism markers in\n                    patients with type 2 diabetes mellitus: A systematic review and\n                    meta-analysis","volume":"34","author":"X Wang","year":"2023","journal-title":"Osteoporos Int"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"101153","DOI":"10.1016\/j.bonr.2021.101153","article-title":"Intravenous zoledronate 4 mg for the treatment of post-menopausal osteoporosis:\n                    A prospective open-labeled study","volume":"16","author":"T Arunthanachaikul","year":"2022","journal-title":"Bone Rep"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2812-1745.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T23:52:44Z","timestamp":1773791564000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2812-1745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":42,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2026,3,17]]},"published-print":{"date-parts":[[2026,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2812-1745","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}