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