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Glucagon-like peptide-1 receptor agonists and fracture risk: a network meta-analysis of randomized clinical trials

Y S Zhang1, W Y Weng1, B C Xie1

  • 1Department of Pharmacy, Guangdong Medical University, No. 1, Xincheng Dadao, Songshan Lake Science and Technology Industry Park, Dongguan, 523808, China.

Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
|August 8, 2018
PubMed

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduce fracture risk in type 2 diabetes patients. Exenatide demonstrates the lowest fracture risk among these agents, making it the preferred choice for bone safety.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Bone Metabolism

Background:

  • Conflicting data exists regarding the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on fracture risk.
  • Type 2 diabetes mellitus (T2DM) patients are a population of interest due to potential bone health implications.

Purpose of the Study:

  • To conduct a network meta-analysis evaluating the association between GLP-1 RAs and fracture risk.
  • To identify the optimal GLP-1 RA agent for minimizing fracture risk in T2DM patients.

Main Methods:

  • Systematic search of electronic databases and ClinicalTrials.gov for relevant randomized controlled trials (RCTs).
  • Bayesian network meta-analysis of 54 RCTs involving 49,602 participants (28,353 on GLP-1 RAs).
  • Estimation of risk ratios (RR) and 95% confidence intervals (CI) to compare fracture risks.

Main Results:

  • GLP-1 RAs were associated with a reduced risk of bone fractures compared to placebo.
  • Exenatide showed the lowest risk of fracture (RR, 0.17; 95% CI 0.03-0.67) and the highest probability of being the safest option.
  • Probabilistic rankings indicated exenatide as the safest, followed by dulaglutide, liraglutide, albiglutide, lixisenatide, and semaglutide.

Conclusions:

  • GLP-1 RAs are linked to decreased bone fracture risk in T2DM patients.
  • Exenatide emerges as the most favorable GLP-1 RA for mitigating fracture risk.
  • Findings support the use of specific GLP-1 RAs for improved bone safety in T2DM management.
Keywords:
FractureGlucagon-like peptide-1 receptor agonistsNetwork meta-analysisType 2 diabetes mellitus

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