SGLT2 inhibitors: no increased fracture risk detected in large database study

  • Abrahami D & al.
  • Diabetes Care
  • 11 Jul 2019

  • International Clinical Digest
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Takeaway

  • Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are not associated with increased fracture risk vs dipeptidyl peptidase 4 inhibitors (DPP4is) in type 2 diabetes, according to results of a large population-based cohort study.

Why this matters

  • Data have conflicted on the association between SGLT2is and fracture risk.
  • Canagliflozin label carries a warning about fractures.

Study design

  • Data from the UK Clinical Practice Research Datalink comparing new users of SGLT2is (n=9454) vs new DDP4i users (n=18,410) over a median of 1.9 years.
  • Funding: Canadian Institutes of Health Research.

Key results

  • There were 1973 fracture events; incidence rate, 12.88 (95% CI, 12.32-13.46) per 1000 person-years.
  • Compared with DPP4i use, SGLT2i use was not associated with fracture risk: HR, 0.97 (95% CI, 0.79-1.19).
  • By SGLT2i type, canagliflozin use was associated with a decreased fracture risk (HR, 0.47; 95% CI, 0.25-0.88), but the result is based on only 10 events.
  • No differences in risk by fracture type, except for a nonsignificantly elevated risk for vertebral fractures with canagliflozin (HR, 1.76; 95% CI, 0.81-3.82).
  • Association did not differ by fracture history, osteoporosis, age, or sex.
  • Results remained consistent in several sensitivity analyses.  

Limitations

  • Observational data.
  • Small event numbers for some analyses.