Effect of Drugs Used in Pharmacotherapy of Type 2 Diabetes on Bone Density and Risk of Bone Fractures

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2024-02, Vol.60 (3), p.393
• Main Authors: Wikarek, Agnieszka, Grabarczyk, Małgorzata, Klimek, Katarzyna, Janoska-Gawrońska, Agata, Suchodolska, Magdalena, Holecki, Michał
• Format: Article
• Language: English
• Subjects: Antidiabetics; antihyperglycemic drugs; Bone Density; Bone marrow; bone metabolism; Bones; Density; Diabetes; diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes therapy; Diabetics; Dipeptidyl-Peptidase IV Inhibitors - pharmacology; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Drug therapy; Fractures; Fractures, Bone - etiology; Fractures, Bone - prevention & control; GLP-1 receptor agonists; Glucagon-Like Peptide 1 - pharmacology; Glucagon-Like Peptide 1 - therapeutic use; Hip joint; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemic agents; Hypoglycemic Agents - therapeutic use; Insulin; Kinases; Metabolism; Metformin - therapeutic use; Osteoporosis; Physiological aspects; Review; Risk factors; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Stem cells; Sulfonylurea Compounds - adverse effects; Thiazolidinediones - therapeutic use; Type 2 diabetes; Women
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60030393

This review summarizes the complex relationship between medications used to treat type 2 diabetes and bone health. T2DM patients face an increased fracture risk despite higher bone mineral density; thus, we analyzed the impact of key drug classes, including Metformin, Sulphonylureas, SGLT-2 inhibitors, DPP-4 inhibitors, GLP-1 agonists, and Thiazolidinediones. Metformin, despite promising preclinical results, lacks a clear consensus on its role in reducing fracture risk. Sulphonylureas present conflicting data, with potential neutral effects on bone. SGLT-2 inhibitors seem to have a transient impact on serum calcium and phosphorus, but evidence on their fracture association is inconclusive. DPP-4 inhibitors emerge as promising contributors to bone health, and GLP-1 agonists exhibit positive effects on bone metabolism, reducing fracture risk. Thiazolidinediones, however, demonstrate adverse impacts on bone, inducing loss through mesenchymal stem cell effects. Insulin presents a complex relationship with bone health. While it has an anabolic effect on bone mineral density, its role in fracture risk remains inconsistent. In conclusion, a comprehensive understanding of diabetes medications' impact on bone health is crucial. Further research is needed to formulate clear guidelines for managing bone health in diabetic patients, considering individual profiles, glycemic control, and potential medication-related effects on bone.