The associations of sodium‐glucose cotransporter‐2 inhibitors versus dipeptidyl peptidase‐4 inhibitors as add‐on to metformin with fracture risk in patients with type 2 diabetes mellitus
Main finding · Any fractureResult — go to the resultAdjusted hazard ratio 1.09 95% CI 0.91–1.31Authors' conclusion
Use of SGLT2 inhibitors was not associated with the risk of any fracture, MOFs or fracture at the individual MOF sites when compared to DPP-4 inhibitor use.
Study context
- Population
- Patients aged ≥18 years with T2D starting a DPP-4i or SGLT2i as add-on to metformin, January 1, 2013–June 30, 2020, Clinical Practice Research Datalink (CPRD) Aurum databasematched cohort
- Participants
- 13,807 vs 28,524
- Exposure
- SGLT2i vs DPP-4i as add-on to metformin
- SGLT2 inhibitorn = 13,807
- DPP-4 inhibitorn = 28,524reference
- Outcome
- Any fracture or major osteoporotic fractures (MOFs)
Methodological detailspropensity-score matched (up to 1:3), Cox proportional hazard models
- Propensity-score matched (up to 1:3)
- Cox proportional hazard models
Main finding
Any fracture
Adjusted hazard ratio
1.09
95% CI 0.91–1.31
SGLT2 inhibitorvs DPP-4 inhibitor
aHR 1.09 (95% CI 0.91–1.31)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| MOFsCurrent use | 0.89 (0.64–1.22) | |
| 0.512Adjusted hazard ratio (log scale) |
Fractures at individual MOF sites
- Risk similar with SGLT2 inhibitor vs DPP-4 inhibitor use
Duration of use, individual SGLT2 inhibitor agents, sex and age strata
- No association with duration of SGLT2 inhibitor use (longest duration >811 days) for any individual agent, or after stratification by sex and age
Original publication
The associations of sodium‐glucose cotransporter‐2 inhibitors versus dipeptidyl peptidase‐4 inhibitors as add‐on to metformin with fracture risk in patients with type 2 diabetes mellitus. Diabetes Obes Metab. Published 28 July 2023. doi:10.
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