New research questions previous link between diabetes drugs and bone fractures

Graphical abstract: Journal of the American Society of Nephrology (2022). DOI: 10.2215 / CJN.16171221

Sodium glucose transport-2 (SGLT-2) inhibitors, which reduce glucose reabsorption by the kidneys, can help control blood sugar levels and protect kidney health in patients with diabetic kidney disease; however, some large clinical trials have linked the medications to a higher risk of bone fractures. In a recent study published in Journal of the American Society of NephrologySGLT-2 inhibitors were not associated with a higher risk of fractures when compared with another diabetes medication, regardless of patients’ kidney function.

The study, which was conducted by Andrea Cowan, MD (London Health Sciences Centre) and her colleagues, compared fracture rates in adults aged 66 years or older who were prescribed SGLT-2 inhibitors vs. those prescribed a different diabetes medication—called dipeptidyl peptidase (DPP-4) inhibitors—that have not been linked to fractures. The analysis included 38,994 new users of an SGLT2 inhibitor and 37,449 new users of a DPP-4 inhibitor in Ontario, Canada. The study excluded individuals with severely decreased kidney function.

Overall, there were 342 fractures at 180 days and 689 fractures at 365 days. There was no difference in fracture risk between individuals prescribed an SGLT-2 inhibitor and those prescribed a DPP-4 inhibitor—both in the whole group and in those with decreased kidney function, who already face an elevated risk of experiencing fractures.

“This study re-assures patients and doctors that SGLT-2 inhibitors are not associated with an increased risk of fracture in patients with chronic kidney disease,” said Dr. Cowan.

An accompanying editorial notes that the study “adds to the growing body of evidence related to the safety of SGLT2 inhibitors, however it should encourage continued basic and clinical studies to determine with more certainty their potential risk of fractures, especially in individuals with more advanced chronic kidney disease.”