Effect of type 2 diabetes medications on fracture risk

Abstract

Type 2 diabetes, one of the most frequent chronic diseases, has an important effect on bone metabolism, with most studies reporting an increased prevalence of fractures in these patients despite an apparently increased bone mineral density. Most probable explanation is an alteration of bone structure/ quality with increased fragility but the different diabetes medications influence the risk of fracture. While metformin and incretin-based therapies are safe, thiazolidinediones and canagliflozin (sodium-glucose cotransporter-2 inhibitor) negatively impact bone metabolism and should be avoided in subjects at increased risk of fractures. Insulin and sulphonylureas are generally safe but can increase the risk of hypoglycemia and falls with subsequent traumatic fractures. Their combination should be avoided, especially in elderly subjects.

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…Some agents have shown divergent effects on bone and skeletal muscles. For example, thiazolidinediones demonstrate detrimental effect on the skeleton and increase fracture risk [ 545 , 599 , 600 , 601 , 602 , 603 , 604 ] but a beneficial effect on muscle atrophy [ 605 ]; other anti-diabetic drugs (sulfonylureas, metformin and possible incretin mimetics) have a neutral or a positive/protective effect on bone health, but they may increase propensity for falls through hypoglycemia (insulin and sulfonylureas) [ 601 , 603 , 604 , 606 ]. When analyzing the complex relationships between OFs and drugs used it should also be taken into account that many medications (corticosteroids, sulfonamides, urea derivatives, vitamin K antagonists, cardiac glycosides, loop diuretics, potassium-sparing diuretics, ACE inhibitors, serotonin reuptake inhibitors, calcium-channel blockers and antiepileptic drugs) may affect the vitamin D status and calcium homeostasis [ 607 , 608 , 609 , 610 , 611 ].…”

Semaphorin3B Promotes Proliferation and Osteogenic Differentiation of Bone Marrow Mesenchymal Stem Cells in a High-Glucose Microenvironment

“…T2DM is a highly prevalent metabolic disease globally and is characterized by excessive blood glucose, insulin resistance, and relative insulin deficiency [16]. T2DM is associated with impaired bone remodeling, osteopenia, osteoporosis, and other diabetes-related bone diseases [17][18][19]. Diabetes mellitus impairs bone metabolism, suppresses bone formation, and impedes fracture healing [20,21].…”

Update on the management of diabetes in long-term care facilities

“…157 158 Furthermore, older adults have more prevalence of osteoporosis or osteopenia and TZD has been associated with a higher rate of fractures, particularly in postmenopausal women. [159][160][161][162] Alpha-1 glucosidase inhibitors This family of medications include miglitol and acarbose. They are a group of drugs that slow carbohydrates absorption by blocking the action of brush border enzymes (alpha glucosidases) and increasing GLP-1 levels.…”

“…The prevalence of HF among older adults in LTCF is estimated to equal 20%–37.4%,157 and using TZD might increase the risk of readmission to the hospital for HF exacerbation or even death 157 158. Furthermore, older adults have more prevalence of osteoporosis or osteopenia and TZD has been associated with a higher rate of fractures, particularly in postmenopausal women 159–162…”