Reduced postprandial bone resorption and greater rise in GLP-1 in overweight and obese individuals after an α-glucosidase inhibitor: a double-blinded randomized crossover trial

• Published in: Osteoporosis international Vol. 32; no. 7; pp. 1379 - 1386
• Main Authors: Kreitman, A., Schneider, S. H., Hao, L., Schlussel, Y., Bello, N. T., Shapses, S. A.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.07.2021; Springer Nature B.V
• Subjects: Body mass index; Body weight; Bone resorption; Bone turnover; Clinical trials; Collagen (type I); Endocrinology; Glucagon; Glucagon-like peptide 1; Medicine; Medicine & Public Health; Obesity; Original Article; Orthopedics; Osteocalcin; Overweight; Placebos; Rheumatology; α-Glucosidase; GLP-1; Bone turnover; Alpha-glucosidase inhibitor; Mixed meal tolerance test; Salacia
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-020-05791-5

Summary When taken with a meal, α-glucosidase inhibitors (α-GI) reduce the rise in postprandial glucose and increase glucagon-like peptide-1 (GLP-1), and this may lower bone turnover. In this study, a salacinol-type α-GI increased GLP-1 and markedly reduced postprandial bone resorption compared to placebo, suggesting it could have implications for bone health. Introduction Animal and clinical trials indicate that α-glucosidase inhibitors attenuate postprandial glycemic indices and increase secretion of GLP-1. In addition, GLP-1 acts on bone by inhibiting resorption. The goal in this study was to determine if a salacinol α-GI alters postprandial bone turnover and can be explained by changes in serum GLP-1. Methods In this double-blind, placebo-controlled crossover study, healthy overweight/obese adults (body mass index 29.0 ± 3.8 kg/m 2 ; 21–59 years; n = 21) received a fixed breakfast and, in random order, were administered Salacia chinensis (SC; 500 mg) or placebo. A fasting blood sample was taken before and at regular intervals for 3 h after the meal. Serum was measured for bone turnover markers, C-terminal telopeptide of type I collagen (CTX) and osteocalcin, and for glycemic indices and gut peptides. Results Compared to placebo, SC attenuated the bone resorption marker, CTX, at 60, 90, and 120 min ( p < 0.05) after the meal, and decreased osteocalcin, at 180 min ( p < 0.05). As expected, SC attenuated the postprandial rise in glucose compared with placebo, whereas GLP-1 was increased at 60 min ( p < 0.05) with SC. Serum GLP-1 explained 41% of the variance for change in postprandial CTX ( p < 0.05). Conclusion This study indicates that attenuating postprandial glycemic indices, with an α-GI, markedly decreases postprandial bone resorption and can be explained by the rise in GLP-1. Future studies should determine whether longer term α-GI use benefits bone health.