Fracture risk not higher with SGLT2 vs DPP4 inhibitors

The use of sodium-glucose transporter 2 (SGLT2) inhibitors among patients with diabetes does not pose an increased risk of developing fractures as compared with dipeptidyl-peptidase 4 (DPP4) inhibitors, and this is true across estimated glomerular filtration rate (eGFR) and albuminuria categories, as shown in a study.

This population-based cohort study used data from the Hong Kong Hospital Authority database and included 28,696 patients with type 2 diabetes who were initiated on either SGLT2 inhibitors (n=14,348) or DPP4 inhibitors (n=14,348). One-to-one propensity score matching was used to match each SGLT2 inhibitor user with one DPP4 inhibitor user.

The primary endpoints were the risks of major osteoporotic fracture (MOF) at 180 and 365 days. Researchers applied Cox proportional hazard regression models to estimate hazard ratios.

MOF occurred in 25 (0.17 percent) SGLT2 inhibitor users and in 24 (0.17 percent) DPP4 inhibitor users (incidence rate, 4.07 vs 3.63 percent 1,000 person-years, respectively) over a follow-up of 180 days, and in 43 (0.30 percent) SGLT2 inhibitor users and 44 (0.31 percent) DPP4 inhibitor users at 365 days  (incidence rate, 4.16 vs 3.64 per 1,000 person-years, respectively).

The risk of MOF did not significantly differ between the SGLT2- and DPP4-inhibitor groups at both 180 days (hazard ratio [HR], 1.13, 95 percent confidence interval [CI], 0.65–1.98; p=0.67) and 365 days (HR, 1.15, 95 percent CI, 0.75–1.75; p=0.52).

Subgroup analyses were consistent across subgroups defined by age, sex, eGFR, albuminuria, and Kidney Disease Improving Global Outcomes categories.