SGLT2 inhibitors do not increase risk of fracture compared with other diabetic medications
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Starting SGLT2 inhibitors among older patients did not increase risk for skeletal fractures compared with the use of dipeptidyl peptidase inhibitors, according to this study.
Further, investigators found skeletal fractures were not associated with the eGFR categories studied.
“Because of their proven cardio- and renoprotective benefits, sodium-glucose cotransporter-2 inhibitors (SGLT2is) are now recommended in all patients with diabetic kidney disease who have an eGFR at least 30 [mL] per min per 1.73 m²,” Andrea Cowan, MD, from the Institute for Clinical and Evaluative Sciences (ICES) in Ontario, Canada, and colleagues wrote. “However, in some large trials, their use has been reported to increase the risk of skeletal fracture.”
In a population cohort study, researchers examined adults at least 66 years old who were new outpatient users of a SGLT2i (canagliflozin, empagliflozin or dapagliflozin) or dipeptidyl peptidase-4 inhibitors (DPP-4i; saxagliptin, sitagliptin or linagliptin) in Ontario, Canada between 2015 and 2019. All patient data were derived from eight health databases at ICES. Patients with either healthy or poor kidney function were included in the study; however, those with severely decreased kidney function were not.
Using linked provincial administration data, researchers compared the incidence of fracture between new users of SGLT2i and DPP-4i. The primary outcome was considered a hospital encounter for a fragility fracture within the first 180 days of a new prescription for either SGLT2i or DPP-4i. Patients attended a follow-up at 365 days.
Researchers used inverse probability of treatment weighting on the basis of propensity scores to balance the two cohorts on indicators of baseline health. Additionally, researchers compared the cumulative incidence rates of fracture between groups for the 180- and 365-day follow-ups. Researchers conducted prespecified subgroup analyses based on eGFR categories (90 mL/min per 1.73 m², 60 mL/min per 1.73 m² to <90 mL/min per 1.73 m², 45 mL/min per 1.73 m² to <60 mL/min per 1.73 m² and 30 mL/min per 1.73 m² to <45 mL/min per 1.73 m²).
A total of 38,994 patients were identified as new users of a SGLT2 inhibitor and 37,449 patients were identified as new users of a DPP-4i. Analyses revealed 342 fractures occurred by 180 days and 689 fractures occurred by 365 days. Overall, the weighted 180- and 365-day risks of a fragility fracture was similar between new users of both inhibitors. Similarly, researchers did not find a correlation between fracture risk and eGFR category.
“This study re-assures patients and doctors that SGLT-2 inhibitors are not associated with an increased risk of fracture in patients with [chronic kidney disease] CKD,” Cowan said in a press release.
Reference:
New research questions previous link between diabetes drugs and bone fractures. https://www.newswise.com/articles/new-research-questions-previous-link-between-diabetes-drugs-and-bone-fractures?sc=cwhr&xy=10007438. Published May 26, 2022. Accessed May 26, 2022.
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