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Fracture rate similar with DPP-IV inhibitors, sulfonylureas
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The risk for incident fractures in adults with type 2 diabetes who recently began antidiabetic medication did not differ between those using DPP-IV inhibitors or sulfonylureas, but the risk was lower with DPP-IV inhibitors compared with thiazolidinediones, according to a study.
“Despite increased reporting of fracture as an outcome in diabetes therapy clinical trials, there still remains a paucity of evidence of the true long-term risk of DPP-IV inhibitor therapies on the occurrence of fragility fractures in the diabetes population compared to other classes of diabetes therapies,” the researchers wrote.
John-Michael Gamble, PhD, associate clinical professor in the School of Pharmacy at the University of Waterloo in Canada, and colleagues evaluated data from the U.K.-based Clinical Practice Research Datalink on 130,326 adults (mean age, 58.8 years; 40% women) diagnosed with type 2 diabetes (mean diabetes duration, 1.3 years; 42% with HbA1c > 9%) between 2007 and 2016 without prior fractures to determine the association between DPP-IV inhibitors and common osteoporotic fragility fractures.
The main analysis of the study evaluated fragility fracture rate between new users of DPP-IV inhibitors (n = 7,993) and new users of sulfonylureas (n = 26,636). The secondary analysis evaluated fragility fracture rates between new users of DPP-IV inhibitors and other antidiabetic drugs. Follow-up was a mean of 1.3 years and a maximum of 9 years.
During 40,203 person-years of follow-up, the incident rate for fracture was higher in the sulfonylurea group (5.2 per 1,000 person-years) compared with the DPP-IV inhibitor group (3 per 1,000 person-years); however, this was no longer significant after adjustment for confounders (adjusted HR = 0.8; 95% CI, 0.51-1.24). Further, no difference was found between DPP-IV inhibitors and insulin for incident fracture rates. The risk for fracture was significantly lower with DPP-IV inhibitors compared with TZDs (aHR = 0.47; 95% CI, 0.26-0.83).
“Findings from this study suggest that new use of a DPP-IV inhibitor in patients with type 2 diabetes does not increase or decrease the change of a fragility fracture compared to new use of a sulfolnylurea or insulin,” Gamble told Endocrine Today. “Our findings provide further evidence regarding the safety of DPP-IV inhibitors in respect to fracture risk. Specifically, data form our study and others suggest that fracture risk is not increased by DPP-IV inihibitor use compared to sulfonylureas or insulin.”
“Further research is needed to better understand differences in fracture risk among specific DPP-IV inhibitors, among long-term users of DPP-IV inhibitors, as well as relative to newer glucose lowering agents such as the SGLT2 inhibitors,” he said. “Importantly, future studies should focus on exploring potential treatment effect modification due to duration of diabetes.” – by Amber Cox
For more information:
John-Michael Gamble, PhD, can be reached at jm.gamble@uwaterloo.ca.
Disclosures: The authors report no relevant financial disclosures.
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