Background: Diabetes is associated with greater risk of fracture. Our aim is to evaluate the correlation of different antidiabetic agents with the risk of fracture among subjects with type 2 diabetes.
Methods: The literature search was conducted in PubMed, Embase, and ClinicalTrials.gov on 22 October 2020. Keywords included “type 2 diabetes,” “fracture,” “randomized controlled trial,” “metformin,” “insulin,” “thiazolinedione,” “sodium-glucose co-transporter-2 inhibitor,” “glucagon-like peptide-1 receptor agonists,” “dipeptidyl peptidase 4 inhibitors” and “sulfonylurea.” Two authors (W-H. T and M-C.T) conducted study selection and data extraction independently. The primary main outcome was the fracture events during the followed-up period pooled by random-effected models.
Results: A total of 214686 patients with diabetes in 188 studies were included and 2850 patients had fracture events. Patients taking sodium-glucose co-transporter-2 inhibitor had higher risk of fracture when compared with glucagon-like peptide-1 receptor agonists (risk ratio [RR] 1.43 [95% confidence interval (CI) 1.08–1.91]) and sulfonylurea (RR 1.45 [95% CI 1.07–1.98]) . Patients taking dipeptidyl peptidase 4 inhibitors also had higher risk of fracture when compared with glucagon-like peptide-1 receptor agonists (risk ratio [RR] 1.4 [95% confidence interval (CI) 1.03–1.91]) and sulfonylurea (RR 1.42 [95% CI 1.03–1.95]) . Metformin, glucagon-like peptide-1 receptor agonists and sulfonylurea had protective effect on fracture when compared with thiazolinedione.
Conclusions: Patients with diabetes taking sodium-glucose co-transporter-2 inhibitor or dipeptidyl peptidase 4 inhibitors had higher risk of fracture when compared with glucagon-like peptide-1 receptor agonists and sulfonylurea. Metformin, glucagon-like peptide-1 receptor agonists and sulfonylurea had protective effect on fracture when compared with thiazolinedione.
W. Tsai: None. S. Kong: None. M. Tsai: None.
