Evidence map›Paper›PMID 29075805›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2018

The effect of insulin on bone mineral density among women with type 2 diabetes: a SWAN Pharmacoepidemiology study.

K Ruppert, J Cauley, Y Lian, J C Zgibor, C Derby, D H Solomon

Open access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 1 pooled it
2.4field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.

  1. Pooled it
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  7. Osteoporosis in Adrenal Insufficiency: Could Metformin be Protective?Indian journal of clinical biochemistry : IJCB · 2025
    Review
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  11. The effect of starting metformin on bone mineral density among women with type 2 diabetes in the Study of Women's Health Across the Nation (SWAN).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 1 country.

K RuppertDepartment of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 4420 Bayard St Suite 600, Pittsburgh, PA, 15260, USA. ruppertk@pitt.edu.ORCID http://orcid.org/0000-0002-3008-6584
J CauleyDepartment of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 4420 Bayard St Suite 600, Pittsburgh, PA, 15260, USA.
Y LianDepartment of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 4420 Bayard St Suite 600, Pittsburgh, PA, 15260, USA.
J C ZgiborDepartment of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA.
C DerbyDepartment of Neurology, Albert Einstein College of Medicine, New York, NY, USA.
D H SolomonDivision of Rheumatology, Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
University of Pittsburgh · USAlbert Einstein College of Medicine · USBrigham and Women's Hospital · USUniversity of South Florida · US

Funding

WOMENS HEALTH ACROSS THE NATION--COORDINATING CENTERU01AG012553 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI BROOKS, MARIA MORI · 1994 to 2019
$37.7M
WOMENS HEALTH ACROSS THE NATION--ENDOCRINE LABU01AG012495 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI MCCONNELL, DANIEL S · 1994 to 2018
$18.8M
WOMENS HEALTH ACROSS THE NATION--PITTSBURGHU01AG012546 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI MATTHEWS, KAREN · 1994 to 2019
$16.2M
WOMENS HEALTH ACROSS THE NATION--UCDAVISU01AG012554 · NIA · UNIVERSITY OF CALIFORNIA DAVIS · PI GOLD, ELLEN B. · 1994 to 2019
$14.5M
WOMENS HEALTH ACROSS THE NATION--UCLAU01AG012539 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI GREENDALE, GAIL A · 1994 to 2018
$13.7M
THE STUDY OF WOMEN'S HEALTH ACROSS THE NATION-MICHIGANU01NR004061 · NINR · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI HARLOW, SIOBAN D · 1994 to 2018
$12.9M
WOMENS HEALTH ACROSS THE NATION--CHICAGOU01AG012505 · NIA · RUSH UNIVERSITY MEDICAL CENTER · PI KRAVITZ, HOWARD M · 1994 to 2019
$11.9M
WOMENS HEALTH ACROSS THE NATION--MASSACHUSETTS GENERAL HU01AG012531 · NIA · MASSACHUSETTS GENERAL HOSPITAL · PI FINKELSTEIN, JOEL S · 1994 to 2019
$10.7M
Women's Health Across the Nation-New Jersey SiteU01AG012535 · NIA · UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL · PI DERBY, CAROL A. · 1994 to 2019
$9.2M
NIA NIH HHS U01 AG012495NIA NIH HHS U01 AG012505NIA NIH HHS U01 AG012531NIA NIH HHS U01 AG012535NIA NIH HHS U01 AG012539NIA NIH HHS U01 AG012546NIA NIH HHS U01 AG012553NIA NIH HHS U01 AG012554NIH HHS Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495NINR NIH HHS U01 NR004061
6 · The paper itself

Abstract

This was a longitudinal study examining the effects of insulin use on bone mineral density loss. Insulin use was found to be associated with greater bone mineral density loss at the femoral neck among women with diabetes mellitus.

introductionWomen with diabetes mellitus (DM) have higher bone mineral density (BMD) and experience slower BMD loss but have an increased risk of fracture. The data regarding the effect of insulin treatment on BMD remains conflicted. We examined the impact of insulin initiation on BMD.

methodsWe investigated the annual changes in BMD associated with the new use of insulin among women with DM in the Study of Women's Health Across the Nation (SWAN). Propensity score (PS) matching, which is a statistical method that helps balance the baseline characteristics of women who did and did not initiate insulin, was used. Covariates with a potential impact on bone health were included in all models. Mixed model regression was used to test the change in BMD between the two groups. Median follow-up time was 5.4 years.

resultsThe cohort consisted of 110 women, mean age, 53.6 years; 49% white and 51% black. Women using insulin (n = 55) were similar on most relevant characteristics to the 55 not using insulin. Median diabetes duration for the user group was 10 vs. 5.0 years for the non-user group. There was a greater loss of BMD at the femoral neck among insulin users (- 1.1%) vs non-users (- 0.77%) (p = 0.04). There were no differences in BMD loss at the spine - 0.30% vs - 0.32% (p = 0.85) or at the total hip - 0.31% vs - 0.25 (p = 0.71), respectively.

conclusionsWomen with T2DM who initiated insulin experienced a more rapid BMD loss at the femoral neck as compared to women who did use insulin.

Indexed as

AdultBone DensityDiabetes Mellitus, Type 2FemaleFemur NeckHip JointHumansHypoglycemic AgentsInsulinLongitudinal StudiesLumbar VertebraeMiddle AgedOsteoporosisUnited StatesHypoglycemic AgentsInsulinBone mineral densityDiabetes mellitusFractureInsulinWomen

Identifiers

PMID29075805
PMCPMC5818624
OpenAlexW2766285934

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.