SGLT2is do not increase fracture risk in type 2 diabetes

Type 2 diabetes patients who use sodium-glucose cotransporter 2 inhibitors (SGLT2is) see no increase in the risk of fractures, a recent Korea study has found.

The study included 42,230 type 2 diabetes patients who were initiated on SGLT2i. Common SGLT2is used included dapagliflozin (54.3 percent), empagliflozin (39.2 percent), and ipragliflozin (6.5 percent). A parallel propensity-score matched comparison cohort of 42,230 individuals taking dipeptidyl peptidase-4 inhibitors (DPP-4is) was also included. The endpoint was the time to first fracture event which was used to compute fracture risk.

SGLT2i treatment did not lead to a significantly higher risk of fractures in both the as-treated (hazard ratio [HR], 0.98, 95 percent confidence interval [CI], 0.92–1.04) and intention-to-treat (HR,0.94, 95 percent CI, 0.89–1.00) analyses. Fracture risk was estimated using Cox proportional hazards models.

Sensitivity analyses did not alter the principal findings. For instance, focusing on individuals who had undergone health screening in the 12-month period prior to cohort enrolment still showed that fractures were no more likely to develop after SGLT2i treatment (intention-to-treat: HR, 0.94, 95 percent CI, 0.86–1.03).

Age, sex, fracture history, prior use of thiazolidinedione all likewise did not affect the null interaction between SGLT2i use and fracture risk.

“Given that bone health issues and the related fracture risk impose a marked economic and social burden, additional research is required to determine the long-term safety of SGLT2i in fractures,” the researchers said.