Effect of dipeptidyl peptidase IV inhibitors, thiazolidinedione, and sulfonylurea on osteoporosis in patients with type 2 diabetes: population-based cohort study

Yang, Bo-Ram; Do, S. H.; Lee, K. E.; Kim, J. W.; Lee, J.; Shin, Kyung‐Jae

doi:10.1007/s00198-020-05801-6

Cited by 10 publications

(12 citation statements)

References 27 publications

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“…There are also no signi cant differences between genders on the prescriptions of statin, oral hypoglycemic agents, or injectable antidiabetic regiments. Particularly, there is no gender-speci c difference on the prescription of thiazolidinedione (TZD), which has been shown to increase the risk of osteoporosis [21] and alter the fat distribution [22]. Other anti-diabetic agents that could potentially change weight or body composition, such as sodium-glucose co-transporter 2 inhibitor (SGLT2i), insulin and glucagon-like peptide 1 receptor agonist (GLP1RA) were also prescribed in both groups without signi cant difference.…”

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

Gender-Specific Impacts of Thigh Skinfold Thickness and Grip Strength for Predicting Osteoporosis in Type 2 Diabetes

Lee

et al. 2023

Preprint

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Background Diabetes with co-existing bone fragility or osteoporosis is common in elderly patients, whereas is frequently underestimated. Methods We conducted dual-energy x-ray absorptiometry (DXA) with 7-site skinfold (SF) and dominant hand grip strength measurements among patients with type 2 diabetes (T2DM) to assess their gender-specific associations. A total of 103 patients with T2DM (60 females and 43 males), aged between 50–80 years (median 68.0 years) were enrolled. Results Our results revealed osteoporosis was negatively correlated with grip strength in both genders, negatively correlated with lean mass solely in males and negatively correlated with fat mass (particular the gynoid fat mass and thigh SF thickness) in females. Via performing multivariable stepwise logistic regression, we identified grip strength in both genders and thigh SF thickness in females as predictors for osteoporosis. Receiver operating characteristic curve analysis further disclosed 20.5 mm female thigh skinfold thickness, 18.1 kg female grip strength and 29.0 kg male grip strength as reasonable cutoff levels for predicting osteoporosis in the Taiwanese patients with T2DM. Conclusions Patients with T2DM presented gender-specific associations between osteoporosis, body composition and grip strength. Grip strength and thigh SF thickness might serve as predictors for early detection of osteoporosis in patients with T2DM.

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Section: Characteristics Of the Study Populationmentioning

confidence: 99%

Gender-Specific Impacts of Thigh Skinfold Thickness and Grip Strength for Predicting Osteoporosis in Type 2 Diabetes

Lee

et al. 2023

Preprint

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“…In terms of thiazolidinediones, risk of fracture seemed to be increased, although no statistically significant difference was achieved, including pioglitazone (RR, 1.14; 95% CI, 0.31-4.25) and rosiglitazone (RR, 1.20; 95% CI, 0.21-6.83). 82,83…”

Section: Antidiabetic Agents and Bonementioning

confidence: 99%

“…82 In terms of sulfonylureas, the data also failed to support the benefits of fracture reduction, although the trend seemed to favor the use of this type of medication for fracture reduction during DM control, including glimepiride (RR, 0.45; 95% CI, 0.31-4.25), glipizide (RR, 0.67; 95% CI, 0.12-3.74), gliclazide (RR, 0.75; 95% CI, 0.05-9.46), and glibenclamide (RR, 0.98; 95% CI, 0.22-4.25). [82][83][84] In terms of thiazolidinediones, risk of fracture seemed to be increased, although no statistically significant difference was achieved, including pioglitazone (RR, 1.14; 95% CI, 0.31-4.25) and rosiglitazone (RR, 1.20; 95% CI, 0.21-6.83). 82,83 In terms of SGLT2 inhibitors, similar to DPP-4i, the results seemed to be varied, although most still failed to show any statistically significant difference between the use of SGLT2 inhibitors and non-SGLT2 inhibitors users.…”

Section: Antidiabetic Agents and Bonementioning

confidence: 99%

“…[82][83][84] In terms of thiazolidinediones, risk of fracture seemed to be increased, although no statistically significant difference was achieved, including pioglitazone (RR, 1.14; 95% CI, 0.31-4.25) and rosiglitazone (RR, 1.20; 95% CI, 0.21-6.83). 82,83 In terms of SGLT2 inhibitors, similar to DPP-4i, the results seemed to be varied, although most still failed to show any statistically significant difference between the use of SGLT2 inhibitors and non-SGLT2 inhibitors users. The canagliflozin (RR, 0.62; 95% CI, 0.13-3.08) and dapagliflozin, (RR, 0.9; 95% CI, 0.16-5.14) seemed to be favorable for fracture reduction, but the empagliflozin (RR, 1.19; 95% CI, 0.24-5.89) and ertugliflozin (RR, 2.47; 95% CI, 0.16-9.95) seemed to increase the fracture rate in the current SGLT2 inhibitor users.…”

Section: Antidiabetic Agents and Bonementioning

confidence: 99%

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To do one and to get more: Part I. Diabetes and bone

Lee

Wang

Yang

et al. 2022

Journal of the Chinese Medical Association

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Type 2 diabetes mellitus (T2DM), is a chronic metabolic disease, characterized by the presence of hyperglycemia and insulin resistance. The key treatment strategies for T2DM include modification of lifestyle, medications, and continuous glucose monitoring. DM patients often have DM-associated morbidities and comorbidities; however, disorders of musculoskeletal system are often neglected, compared to other major systems in DM patients. Based on sharing similar pathophysiology of DM and osteoporosis, it is supposed that the use of antidiabetic agents (ADAs) may not only provide the lowering glucose level effect and the maintenance of the sugar homeostasis to directly delay the tissue damage secondary to hyperglycemia but also offer the benefits, such as the prevention of developing osteoporosis and fractures. Based on the current review, evidence shows the positive correlation between DM and osteoporosis or fracture, but the effectiveness of using ADA in the prevention of osteoporosis and subsequent reduction of fracture seems to be inconclusive. Although the benefits of ADA on bone health are uncertain, the potential value of "To do one and to get more" therapeutic strategy should be always persuaded. At least, one of the key treatment strategies as an establishment of healthy lifestyle may work, because it improves the status of insulin resistance and subsequently helps DM control, prevents the DM-related micro-and macrovascular injury, and possibly strengthens the general performance of musculoskeletal system. With stronger musculoskeletal system support, the risk of "fall" may be decreased, because it is associated with fracture. Although the ADA available in the market does not satisfy the policy of "To do one and to get more" yet, we are looking forward to seeing the continuously advanced technology of drug development on diabetic control, and hope to see their extra-sugar-lowering effects.

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“…In addition to the direct effects of diabetes on bone fragility, current medical management of T2DM also substantially impacts bone health and fracture risk ( 22 , 23 ). For instance, thiazolidinediones have been associated with an increased fracture risk ( 24 , 25 ), whereas metformin administration has been shown to have a protective effect on the bone health of diabetic patients ( 24 – 26 ).…”

Section: Introductionmentioning

confidence: 99%

Association of metformin use with fracture risk in type 2 diabetes: A systematic review and meta-analysis of observational studies

Yu¹,

Ye²,

Li³

et al. 2023

Front. Endocrinol.

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AimsIncreasing evidence suggests that metformin can affect bone metabolism beyond its hypoglycemic effects in diabetic patients. However, the effects of metformin on fracture risk in type 2 diabetes mellitus (T2DM) patients remain unclear. A systematic review and meta-analysis were performed in this study to evaluate the association between metformin application and fracture risk in T2DM patients based on previous studies published until June 2021.MethodsA systematic search was performed to collect publications on metformin application in T2DM patients based on PubMed, Embase, Cochran, and Web of Science databases. Meta-analysis was performed by using a random-effects model to estimate the summary relative risks (RRs) with 95% confidence intervals (CIs). Subgroup analyses based on cohort/case-control and ethnicity and sensitivity analyses were also performed.ResultsEleven studies were included in the meta-analysis. Results demonstrated metformin use was not significantly associated with a decreased risk of fracture (RR, 0.91; 95% CI, 0.81–1.02; I2 = 96.8%). Moreover, metformin use also demonstrated similar results in subgroup analyses of seven cohort studies and four case-control studies, respectively (RR, 0.90; 95% CI, 0.76–1.07; I2 = 98.0%; RR, 0.96; 96% CI, 0.89–1.03; I2 = 53.7%). Sensitivity analysis revealed that there was no publication bias.ConclusionThere was no significant correlation between fracture risk and metformin application in T2DM patients. Due to a limited number of existing studies, further research is needed to make a definite conclusion for clinical consensus.

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Effect of dipeptidyl peptidase IV inhibitors, thiazolidinedione, and sulfonylurea on osteoporosis in patients with type 2 diabetes: population-based cohort study

Cited by 10 publications

References 27 publications

Gender-Specific Impacts of Thigh Skinfold Thickness and Grip Strength for Predicting Osteoporosis in Type 2 Diabetes

Gender-Specific Impacts of Thigh Skinfold Thickness and Grip Strength for Predicting Osteoporosis in Type 2 Diabetes

To do one and to get more: Part I. Diabetes and bone

Association of metformin use with fracture risk in type 2 diabetes: A systematic review and meta-analysis of observational studies

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