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Background. Glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) are an intriguing class of antihyperglycemic drugs for type 2 diabetes mellitus (T2DM). Such drugs not only play a primary role in regulating blood glucose levels but also exhibit additional pleiotropic effects, including potential impacts on bone metabolism and fracture risk. However, the mechanism of such drugs is unclear. The purpose of this study was to evaluate the effect of GLP‐1 RAs on bone metabolism in T2DM. Methods. From database inception to May 1, 2023, the searches were conducted on multiple databases such as Web of Science, Embase, PubMed, CNKI, the Cochrane Library, Wanfang, and VIP. We systematically collected all randomized controlled trials of bone metabolism in patients with T2DM treated with GLP‐1 RAs. The quality evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was analyzed using Review Manager 5.4 software, and funnel plots were drawn to evaluate publication bias. Results. Twenty‐six randomized controlled trials that met the inclusion criteria were included, involving a total of 2268 participants. In this study, compared to other antidiabetic drugs or placebo, GLP‐1 RAs were found to significantly increase serum calcium (mean difference (MD) = 0.05, 95% confidence interval (CI) (0.01, 0.09), P = 0.002], bone alkaline phosphatase [standardized MD (SMD) = 0.76, 95% CI (0.29, 1.24), and P = 0.001), and osteocalcin (SMD = 2.04, 95% CI (0.99, 3.08), and P = 0.0001) in T2DM. Specifically, liraglutide increased procollagen type 1 N‐terminal propeptide (SMD = 0.45, 95% CI (0.01, 0.89), and P = 0.04). GLP‐1 RAs were also associated with a reduction in cross‐linked C‐terminal telopeptides of type I collagen (SMD = −0.36, 95% CI (−0.70, −0.03), and P = 0.03). In additionally, GLP‐1 RAs increased lumbar spine bone mineral density (BMD) (SMD = 1.04, 95% CI (0.60, 1.48), and P < 0.00001) and femoral neck BMD (SMD = 1.29, 95% CI (0.36, 2.23), and P = 0.007). Conclusions. GLP‐1 RAs can not only improve BMD in the lumbar spine and femoral neck of patients with T2DM but also protect bone health by inhibiting bone resorption and promoting bone formation. Systematic Review Registration. PROSPERO, identifier CRD42023418166. [ABSTRACT FROM AUTHOR]

Objective. To investigate the differences in the awareness, knowledge, and management of osteoporosis from a cohort of medical staff after educational intervention. Methods. A total of 653 medical workers from different departments related to the prevention and treatment of osteoporosis from 7 hospitals in Ningxia were enrolled. Information was collected using a designed questionnaire. Results. After 5 years of educational intervention and follow-up, medical staff had an increased understanding of osteoporosis diagnosis, including dual-energy X-ray, ultrasound bone sonometer, fragility fracture history, biochemistry markers, and the awareness of the susceptible population. However, there was no improvement in the cognition of single/dual photo absorptiometry, symptoms and signs, and bone turnover index. Their understanding of antiosteoporosis drugs, especially the application of calcitonin, diphosphates, and vitamin D, was significantly promoted, while the perception of indicators and time in follow-up, some adverse drug reactions, and exercise therapy remained unchanged. Medical staff were remarkably less aware of the management of follow-up for osteoporosis, exercise and diet therapy, and bone turnover markers. Conclusion. A great gap was identified in the perception of osteoporosis among medical staff in the Ningxia region. After the educational intervention, the knowledge regarding some aspects of osteoporosis generally improved. Much more effort should be made to strengthen the training and learning on the special detection methods of osteoporosis, medications and exercise therapy, and follow-up management. [ABSTRACT FROM AUTHOR]

Objective. The risk factors for the most common adverse reactions of two types of antiosteoporosis drugs in the first treatment of postmenopausal osteoporosis were analyzed to investigate the relationship between the occurrence of adverse reactions and different bone transition states and vitamin D levels. Methods. A total of 381 postmenopausal women who were diagnosed with osteoporosis in the Osteoporosis Clinic of Ningxia Medical University General Hospital from January 2017 to June 2020 were enrolled. A telephone follow-up survey was conducted on the mentioned subjects. According to the survey results, the mentioned subjects were selected according to their first use of antiosteoporosis drugs. They were divided into zoledronic acid and teriparatide acetate groups. The subjects in the two groups were divided into two groups according to the presence or absence of adverse reactions after medication and according to vitamin D level and P1NP level, and the correlation between the two factors and the occurrence of adverse reactions was analyzed. Results. Among the 307 patients treated with zoledronic acid for antiosteoporosis, 99 patients developed acute phase adverse reactions (APR+), accounting for 32.2% of the total subjects. 56.7 percent of the subjects had vitamin D deficiency. The 25(OH)D level of the APR + subjects was 16.75 ± 9.20 ng/mL, significantly lower than that of the APR− patients (23.68 ± 10.67 ng/mL). Serological P1NP level in APR+ patients was 73.95 ± 34.50 ng/ml, significantly higher than that of APR− patients with 55.80 ± 36.91 ng/ml. Musculoskeletal symptoms were observed in 14 of the 74 subjects treated with teriparatide acetate, accounting for 18.9% of the total subjects. The 25(OH)D level was deficient in 59.5% of the subjects. The 25(OH)D level of the subjects with musculoskeletal symptoms was 15.96 ± 8.17 ng/ml, while that of the subjects without musculoskeletal symptoms was 20.86 ± 8.52 ng/ml, which showed no statistical significance. The reason was considered to be related to the small sample size included in the study. The P1NP level of subjects with musculoskeletal symptoms was 96.85 ± 58.52 ng/ml, significantly higher than the P1NP level of subjects without musculoskeletal symptoms (55.28 ± 27.87 ng/ml). Conclusions. The 25(OH)D level in vivo was negatively correlated with the acute phase adverse reactions after the first infusion of zoledronic acid. When the rate of bone formation is increased and osteoblasts are active, the risk of acute phase adverse reactions is increased with the use of zoledronic acid as antiosteoporosis therapy. There was no significant correlation between 25(OH)D levels and musculoskeletal symptoms after teriparatide acetate treatment of osteoporosis. When the rate of bone formation is increased and osteoblasts are active, the risk of adverse reactions to musculoskeletal symptoms is increased with antiosteoporosis treatment with teriparatide acetate. [ABSTRACT FROM AUTHOR]