Bone Fractures with Sodium-Glucose Co-transporter-2 Inhibitors: How Real is the Risk?

Area of Science:

• Endocrinology
• Pharmacology
• Metabolic Diseases

Background:

• Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are used for type 2 diabetes.
• Recent FDA warnings highlight potential bone fracture risks associated with canagliflozin.
• Concerns exist regarding the impact of SGLT2i on bone health, necessitating a review of current evidence.

Purpose of the Study:

• To summarize existing evidence on the association between SGLT2 inhibitors and bone fractures.
• To discuss potential mechanisms linking SGLT2 inhibitors to adverse bone effects.
• To provide expert opinion for clinicians navigating the conflicting data on SGLT2i and bone health.

Main Methods:

• Review of available scientific literature and regulatory communications regarding SGLT2 inhibitors and bone fractures.
• Analysis of studies investigating effects on bone mineral density and biochemical markers.
• Synthesis of evidence to inform clinical interpretation.

Main Results:

• The US FDA strengthened warnings for canagliflozin due to increased fracture risk and decreased bone mineral density.
• Potential mechanisms include altered parathyroid hormone and vitamin D levels.
• Some studies on dapagliflozin show no adverse effects on bone health, indicating class variability.

Conclusions:

• The evidence regarding SGLT2 inhibitors and bone fracture risk is conflicting and not fully conclusive.
• Expert interpretation is crucial for clinicians managing patients on SGLT2 inhibitors.
• Further research is warranted to clarify the long-term effects of SGLT2 inhibitors on bone metabolism.