Association of sodium-glucose cotransporter 2 inhibitor use with risk of osteoporotic fracture among older women: A nationwide, population-based cohort study

• Published in: Diabetes research and clinical practice 2024-07, Vol.213, p.111712, Article 111712
• Main Authors: Lee, Seunghyun, Yu, Min Heui, Hong, Namki, Kim, Kyoung Jin, Kim, Hae Kyung, Rhee, Yumie, Lee, Minyoung, Kim, Kyoung Min
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cohort Studies; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Female; Fracture; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Incidence; Osteoporosis; Osteoporotic Fractures - chemically induced; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - prevention & control; Republic of Korea - epidemiology; Risk Factors; SGLT2 inhibitor; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Spinal Fractures - chemically induced; Spinal Fractures - epidemiology; Women
• ISSN: 0168-8227; 1872-8227; 1872-8227
• DOI: 10.1016/j.diabres.2024.111712

[Display omitted] •Data on sodium-glucose cotransporter 2 inhibitor (SGLT2i) use-associated fracture risk in vulnerable populations are limited.•We aimed to investigate SGLT2i increases the risk of fracture, especially in older women.•In elderly women with type 2 diabetes, SGLT2i use was linked to a 40% higher risk of vertebral fractures than non-SGLT2i use.•SGLT2i should be cautiously prescribed in older women at high risk of vertebral fractures. We investigated the relationship between sodium-glucose cotransporter-2 inhibitor (SGLT2i) and fracture in elderly women diagnosed with type 2 diabetes mellitus (T2DM) and newly prescribed antidiabetic medications (ADMs). We used the population-based cohort study data from the National Health Insurance Service of Korea (2013–2020). Women ≥65 years old with T2DM, who were newly prescribed ADMs other than glucagon-like peptide-1 receptor agonists and thiazolidinedione, and who had comprehensive health check-up data were included. A total of 1,333 SGLT2i users were matched in a 1:2 ratio with 2,626 non-SGLT2i users. After propensity score matching, mean age, body mass index, number of ADMs, and other covariates were well-balanced between SGLT2i users and non-SGLT2i users. During the follow-up period, a higher incidence of vertebral fractures in SGLT2i users than in non-SGLT2i users (incidence rate 19.2 vs. 13.8 per 1,000 person-years; hazard ratio 1.40, 95 % confidence interval 1.00–1.96, p = 0.049). No significant difference was noted in other types of fracture. SGLT2i use showed an increased risk of vertebral fracture than non-SGLT2i use in elderly women. Although further validation is required, SGLT2i should be cautiously prescribed in older women due to the potential association with fracture risk.