Evidence mapPaperPMID 42091768Full record

SynthesisArchives of osteoporosis2026

Impact of metformin on bone turnover markers: a systematic review and meta-analysis of clinical trials.

Mohammadreza Heidari, Niloofar Mirdamadi, Pouria Khashayar, Ozra Tabatabaei-Malazy, Marzieh Golabchi, Patricia Khashayar

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Archives of osteoporosis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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.

Mohammadreza Heidari *Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Niloofar Mirdamadi *Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Pouria KhashayarSchool of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
Ozra Tabatabaei-MalazyNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. tabatabaeiml@sina.tums.ac.ir.ORCID 0000-0003-0188-9721
Marzieh GolabchiNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Patricia KhashayarInternational Institute for Biosensing, University of Minnesota, Minneapolis, USA.

Funding

Tehran University of Medical Sciences & health services 1401-3-221-63420
6 · The paper itself

Abstract

Metformin is widely used for diabetes, but its effects on bone health are uncertain. This meta-analysis study found that it reduces markers of both bone loss and bone formation. It is still unclear whether this benefits or harms bones long term, highlighting the need for larger, longer clinical studies. PURPOSE: Metformin is a widely used antidiabetic drug that has shown potential effects on bone metabolism. However, its impact on bone turnover markers remains unclear. This systematic review and meta-analysis aimed to assess this effect.

methodsA comprehensive search was conducted across PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases, identifying clinical trials published up to February 04, 2026, that evaluated the effects of metformin on validated bone turnover markers. The quality and risk of bias were assessed using the Modified Jadad Scale, and Cochrane Collaboration's risk of bias tool, respectively. A random-effects meta-analysis was performed to estimate the standardized mean difference (SMD) with a 95% confidence interval.

resultsFourteen studies met the inclusion criteria, involving diabetic and non-diabetic populations. Metformin significantly reduced both bone resorption, bone formation markers (SMD: -1.28 [95% CI: -2.03, -0.52], I

conclusionMetformin appears to lower overall bone turnover, reducing both bone resorption and bone formation markers. However, given the high heterogeneity across studies and the reliance on surrogate biochemical endpoints rather than fracture or bone mineral density outcomes, the clinical significance of these findings remains uncertain. Larger, long-term trials are needed to determine whether metformin provides real benefits or risks for osteoporosis.

Indexed as

Bone RemodelingHypoglycemic AgentsMetforminBiomarkersBone ResorptionClinical Trials as TopicHumansOsteogenesisBiomarkersHypoglycemic AgentsMetforminBone metabolismBone turnover markersDiabetesMetforminOsteoporosis

Identifiers

What Socratic holds

Textmetadata
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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 Socratic graph.