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Metformin adherence is associated with lower risk of osteoporotic fracture among patients with advanced type 2
Chien-Lung Chen1, Shun-Neng Hsu2, Li-Nien Chien3
1Taipei Hospital, Ministry of Health and Welfare, No. 127 Siyuan Rd., Xinzhuang Dist., New Taipei City 242033, Taiwan, ROC; Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, No. 155 Sec. 2 Linong St., Beitou Dist., Taipei City 112304, Taiwan, ROC.
Aims:
To evaluate whether adherence to concurrent metformin (MET) therapy is associated with a reduced risk of fractures among patients with type 2 diabetes mellitus (T2DM).
Methods:
This retrospective cohort study used Taiwan's nationwide claims data from 2014 to 2020 to identify patients aged ≥50 years with T2DM who initiated second-line oral antidiabetic therapy while continuing MET. Patients with a prior history of fractures were excluded. MET adherence was defined as a medication possession ratio >40 % and a refill gap ≤90 days. Fractures were identified through inpatient and outpatient claims using specific diagnosis and procedure codes related to fracture treatment and surgical intervention. Propensity score matching (1:1) was used to balance baseline characteristics, and competing risk regression was applied to estimate fracture risk, accounting for the competing risk of death.
Results:
A total of 76,022 patients were included (38,011 per group). MET adherence was significantly associated with a reduced risk of all-site fractures (adjusted subdistribution hazard ratio[aSHR] = 0.76; 95 % CI: 0.69-0.83; P < 0.001), with consistent effects across fracture sites. No additional benefit was observed with concurrent use of DPP4i or SGLT2i.
Conclusions:
MET adherence was associated with lower fracture risk in older adults with T2DM, highlighting its potential role in fracture prevention.
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