Related Experiment Video

Updated: Feb 17, 2026

Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
04:41

Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner

Published on: June 6, 2025

1.2K

Initiation of dapagliflozin and treatment-emergent fractures

Konstantinos A Toulis1,2, John P Bilezikian3, G Neil Thomas1

  • 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK.

Diabetes, Obesity & Metabolism
|December 2, 2017
PubMed

Insights

This study found no increased fracture risk in type 2 diabetes patients starting dapagliflozin. The sodium-glucose co-transporter-2 (SGLT2) inhibitor class was investigated for fracture risk, with dapagliflozin showing no significant difference compared to standard treatment.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Epidemiology

Background:

  • Fracture risk is a concern in type 2 diabetes mellitus (T2DM).
  • Canagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, has been linked to increased fracture risk.
  • The fracture risk associated with dapagliflozin initiation in T2DM patients remains unclear.

Purpose of the Study:

  • To investigate the association between dapagliflozin initiation and fracture risk in patients with T2DM.
  • To compare the risk of fragility fractures and any fractures in T2DM patients treated with dapagliflozin versus standard antidiabetic treatment.

Main Methods:

  • Population-based, open cohort study using The Health Improvement Network (THIN) database (January 2013-January 2016).
  • Included 22,618 T2DM patients (4,548 exposed to dapagliflozin, 18,070 controls), matched for age, sex, BMI, and diabetes duration.
  • Used Cox regression to calculate adjusted hazard rate ratios (HRs) for fragility fractures and any fractures.

Main Results:

  • No significant difference in the risk of fragility fractures between dapagliflozin users and controls (adjusted HR 0.87, 95% CI 0.56-1.35).
  • No significant difference in the risk of any fracture between the groups (adjusted HR 0.89, 95% CI 0.66-1.20).
  • Sensitivity analyses in high-risk populations yielded similar results, indicating no increased fracture risk.

Conclusions:

  • Initiation of dapagliflozin in patients with T2DM is not associated with an increased risk of treatment-emergent fractures.
  • Findings suggest dapagliflozin may have a different fracture risk profile compared to other SGLT2 inhibitors.
  • Further research may be warranted to fully elucidate the fracture risk across the SGLT2 inhibitor class.
Keywords:
fracture risk assessmentpractice/policy-related issuessodium-glucose co-transporter inhibitorsstatistical methodstherapeutics

More Related Videos

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device04:19

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

Published on: November 8, 2024

1.5K
Sequential In vivo Imaging of Osteogenic Stem/Progenitor Cells During Fracture Repair10:30

Sequential In vivo Imaging of Osteogenic Stem/Progenitor Cells During Fracture Repair

Published on: May 23, 2014

11.1K

Related Concept Videos

Dipeptidyl Peptidase 4 Inhibitors01:23

Dipeptidyl Peptidase 4 Inhibitors

Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
729
Fractures: Bone Repair01:27

Fractures: Bone Repair

Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
5.7K
Oral Hypoglycemic Agents: Glinides01:06

Oral Hypoglycemic Agents: Glinides

Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
705
Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

Oral Hypoglycemic Agents: Biguanides and Glitazones

Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
698
Glucagon-like Receptor Agonists01:24

Glucagon-like Receptor Agonists

Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
1.0K
Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
864