Can anti-diabetic drug use affect fracture risk in patients with type 2 diabetes?

This study evaluated the safety of anti-diabetic drugs in the risk of fractures based on available data from clinical trials. The data showed differences in associations between the use of anti-diabetic drugs and fracture risk.

Patients with type 2 diabetes (T2D) are more prone to bone fragility (increased bone fracture risk). This is possibly related to a deteriorated bone tissue or decreases in bone mineral levels in tissues (bone mineral density; BMD).

Bone fractures can have serious consequences for patients with T2D. Currently, it remains unclear whether anti-diabetic drug therapies may also affect bone quality in patients with T2D. There is a need to investigate the association between fracture risk and anti-diabetic drug use.   

This review included 117 studies with 221,364 patients that had T2D. A wide range of anti-diabetic drugs was used among studies. Fracture effects of anti-diabetic drug use were recorded. 

All fractures were graded as high or moderate quality in this review. Trelagliptin (Zafatek), a DPP-4 inhibitor, was associated with a significantly higher (by 3.51 times) risk of fractures compared to placebo. Other DPP-4 inhibitors such as omarigliptin (Marizev), sitagliptin (Januvia), vildagliptin (Galvus), and saxagliptin (Onglyza) were also associated with a higher risk of fractures compared to placebo.

Albiglutide (Tanzeum), a GLP-1 receptor agonist was associated with a 71% lower risk of fractures compared to placebo. Other GLP-1 receptor agonists such as dulaglutide (Trulicity), exenatide (Byetta), liraglutide (Saxenda), semaglutide (Ozempic), and lixisenatide (Lyxumia) were associated with slightly lower risks of fractures compared to placebo.

Voglibose (Voglib), an α-glucosidase inhibitor, significantly decreased the risk of fracture compared to placebo by 97%. Other anti-diabetic drugs may increase or decrease the risk of fractures, however, no significant differences were found.

The study indicated that some anti-diabetic drugs can influence the risk of fractures. The authors suggest that there is a need to weigh drug effectiveness with treatment benefits and risks for patients.

Limited data were available for some anti-diabetic drugs in a few studies, so their effects could not be evaluated. In some cases, combining data for fracture effects was not possible due to limited data.