Z Al-Mashhadi1,2, R Viggers3,4, R Fuglsang-Nielsen1,5, F de Vries6,7, J P van den Bergh8,9,10, T Harsløf11, B Langdahl2,11, S Gregersen1,11, Jakob Starup-Linde12,13. 1. Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark. 2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 3. Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark. 4. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 5. Department of Internal Medicine, Regional Hospital Horsens, Horsens, Denmark. 6. Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands. 7. Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands. 8. Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands. 9. Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands. 10. Faculty of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium. 11. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark. 12. Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark. jakolind@rm.dk. 13. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark. jakolind@rm.dk.
Abstract
PURPOSE OF REVIEW: Diabetes mellitus (DM) is associated with increased fracture risk. The aim of this systematic review was to examine the effects of different classes of glucose-lowering drugs on fracture risk in patients with type 2 DM. The heterogeneity of the included studies did not allow formal statistical analyses. RECENT FINDINGS: Sixty studies were included in the review. Metformin, dipeptidylpeptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter 2-inhibitors do not appear to increase fracture risk. Results for insulin and sulphonylureas were more disparate, although there may be an increased fracture risk related to hypoglycemia and falls with these treatments. Glitazones were consistently associated with increased fracture risk in women, although the evidence was sparser in men. New glucose-lowering drugs are continuously being developed and better understanding of these is leading to changes in prescription patterns. Our findings warrant continued research on the effects of glucose-lowering drugs on fracture risk, elucidating the class-specific effects of these drugs.
PURPOSE OF REVIEW: Diabetes mellitus (DM) is associated with increased fracture risk. The aim of this systematic review was to examine the effects of different classes of glucose-lowering drugs on fracture risk in patients with type 2 DM. The heterogeneity of the included studies did not allow formal statistical analyses. RECENT FINDINGS: Sixty studies were included in the review. Metformin, dipeptidylpeptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter 2-inhibitors do not appear to increase fracture risk. Results for insulin and sulphonylureas were more disparate, although there may be an increased fracture risk related to hypoglycemia and falls with these treatments. Glitazones were consistently associated with increased fracture risk in women, although the evidence was sparser in men. New glucose-lowering drugs are continuously being developed and better understanding of these is leading to changes in prescription patterns. Our findings warrant continued research on the effects of glucose-lowering drugs on fracture risk, elucidating the class-specific effects of these drugs.