Bone Fractures with Sodium-Glucose Co-transporter-2 Inhibitors: How Real is the Risk?
This article succinctly summarizes the available evidence on the risk of bone fractures with sodium-glucose co-transporter-2 inhibitors. The US Food and Drug Administration has strengthened the warning for canagliflozin related to the increased risk of bone fractures, and added new information about decreased bone mineral density. The agency has also said that it will evaluate the risk of bone fractures with other drugs in the sodium-glucose co-transporter-2 inhibitor class. Increases in parathyroid hormone levels and decreases in 1,25-dihydroxyvitamin D levels have been postulated as possible mechanisms. In contrast, some studies with dapagliflozin have shown no effects on bone health. Because a consensus has not been reached, we believe that an expert opinion on how to interpret the available evidence would be of great benefit for clinicians.
Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy. edoardo.mannucci@unifi.it.|Diabetology, Careggi Teaching Hospital, AOU Careggi, Ponte Nuovo-Via delle Oblate 4, 50134, Florence, Italy. edoardo.mannucci@unifi.it.
Edoardo
E
Mannucci
Diabetology, Careggi Teaching Hospital, AOU Careggi, Ponte Nuovo-Via delle Oblate 4, 50134, Florence, Italy.
Matteo
M
Monami
D000818:Animals; D001559:Benzhydryl Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D015519:Bone Density / Q000187:drug effects; D000068896:Canagliflozin / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D004348:Drug Labeling; D050723:Fractures, Bone / Q000139:chemically induced* / Q000453:epidemiology; D005960:Glucosides / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D010281:Parathyroid Hormone / Q000097:blood; D012306:Risk; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D014481:United States; D014486:United States Food and Drug Administration; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
D001559:Benzhydryl Compounds; D005960:Glucosides; D007004:Hypoglycemic Agents; D010281:Parathyroid Hormone; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D000068896:Canagliflozin; D014807:Vitamin D; C529054:dapagliflozin; C097949:1,25-dihydroxyvitamin D