Effect of SGLT2 inhibitors versus DPP4 inhibitors on major and non-major osteoporotic fracture risks among general and high-risk type 2 diabetes patients: A nationwide retrospective cohort study
Authors' conclusion
This study adds supporting real-world evidence for SGLT2is-associated bone safety for a wide range of fractures, which promotes the rational use of SGLT2is in routine care and highlights the importance of the close monitoring of patients with high fracture risks to maximize treatment benefits while reducing undesirable effects.
Study context
- Population
- Patients with T2D newly and stably using SGLT2i or DPP-4i in 2017, Taiwan's National Health Insurance Research Database; follow-up until fracture, loss of follow-up, death or December 31, 2018propensity-score matched
- Exposure
- SGLT2i vs DPP-4i
- Outcome
- Major fracture
- Follow-up
- 2 years
Methodological detailsnationwide, propensity-score matched
- Nationwide
- Propensity-score matched
Main finding
As reported in the abstract
Each group vs DPP4iHazard ratio (95% CI)
SGLT2i
0.89(0.80–1.00)
Each group vs DPP4iRMST difference, days (95% CI)
SGLT2i
1.51(−0.17 to 3.17)
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | |
|---|---|---|
| Non-major fracture · 2 yearsSGLT2ivs DPP4i | 0.89 (0.81–0.98) | |
| 0.512Hazard ratio (log scale) |
| Outcome | RMST difference (days) (CI) | |
|---|---|---|
| Non-major fracture · 2 yearsSGLT2ivs DPP4i | 2.44 (0.47–4.37) | |
| −20246Difference, days (linear scale) |
180-day lag time analysis
- Consistent results with primary findings
Safety
Major fractures in high-risk subgroups
- SGLT2i-associated harmful effect on major (not non-major) fractures in women and those with diabetes duration ≥ 8 years, prior fractures or established osteoporosis
Original publication
Effect of SGLT2 inhibitors versus DPP4 inhibitors on major and non-major osteoporotic fracture risks among general and high-risk type 2 diabetes patients: A nationwide retrospective cohort study. Diabetes Metab. Published 12 July 2023. doi:10.
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