A recent meta-analysis published in Diabetes Therapy suggests that dipeptidyl peptidase-4 (DPP-4) inhibitors do not influence the risk for fractures compared with other anti-diabetic drugs or placebo in patients with type 2 diabetes mellitus (T2DM).
Researchers conducted a meta-analysis of 87 randomised controlled trials (n=93,772) identified through a literature search across the Medline, Embase, Cochrane Library and the ClinicalTrials.gov databases. The included studies compared five DPP-4 inhibitors: sitagliptin, saxagliptin, alogliptin, linagliptin and vildagliptin with active control drugs or placebo.
A total of 676 fractures were seen in the DPP-4 inhibitor treatment group and 646 in the control group. Overall, the use of DPP-4 inhibitors in patients with T2DM did not influence the risk for fractures, irrespective of comparison with placebo or active comparators (Mantel–Haenszel OR, 1.01; 95% CI, 0.90-1.12; P=.92; I2=0%). A sub-group-analysis showed that there was no statistically significant difference in the risk for fracture between different DPP-4 inhibitors (P=.70). Additionally, a sub-group analysis based on the duration of DPP-4 inhibitor therapy demonstrated no significant difference in the risk for fractures (P=.90).
The authors said: "Treatment of diabetic patients with DPP-4 inhibitors, which is thus usually independent of the risk of fracture, can be considered as an advantage worth mentioning compared with drugs such as thiazolidinedione or exenatide, which are known to increase the risk of fracture."