ArticleClinical journal of the American Society of Nephrology : CJASN2022
Fracture Risk of Sodium-Glucose Cotransporter-2 Inhibitors in Chronic Kidney Disease.
Article in Clinical journal of the American Society of Nephrology : CJASN, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Risk of bone fracture by using dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, or sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes mellitus: a network meta-analysis of population-based cohort studies.Frontiers in endocrinology · 2024Pooled it
- Efficacy and Safety of Dapagliflozin in Patients With Chronic Kidney Disease Across the Spectrum of Frailty.The journals of gerontology. Series A, Biological sciences and medical sciences · 2024Trial
- SGLT2i use and fracture risk compared with DPP4i in patients with T2DM.Journal of diabetes investigation · 2026Article
- Genetics of Response to Canagliflozin (GRC) Study: Rationale, Design, and Pharmacodynamic Responses.Clinical and translational science · 2026Article
- Bone from Healthy Individuals and Patients with CKD Expresses the Sodium-Glucose Co-transporter-2 (SGLT2).Calcified tissue international · 2026Article
- Fracture incidence and osteoporosis treatment in Parkinson's disease: a population-based cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Ferroptosis regulation by SGLT2 inhibitors: mechanisms and clinical benefits in diabetic kidney disease.Frontiers in pharmacology · 2026Review
- The Association of SGLT2i vs DPP4i on Fracture: A Cohort Study in Veterans with Diabetes.American journal of medicine open · 2025Article
- Diabetic bone fragility through advanced glycation end product-collagen axis: Mechanisms and therapy of sodium glucose cotransporter 2 inhibitors.World journal of diabetes · 2025Review
- The use of SGLT2 inhibitors in older people: What is important?Aging clinical and experimental research · 2025Review
- Monitoring, Control, and Clinical Outcomes Associated With Chronic Kidney Disease-Mineral Bone Disorder: A Population-Based Cohort Study in Ontario, Canada.Kidney medicine · 2025Article
- The use of SGLT2 inhibitors and GLP-1 receptor agonists in older patients: a debate on approaches in CKD and non-CKD populations.Clinical kidney journal · 2025Article
- Author's Reply to Peronard and Mayntz: "SGLT2 Inhibitors, and How They Work Beyond the Glucosuric Effect".American journal of cardiovascular drugs : drugs, devices, and other interventions · 2025Article
- Risk of fracture with sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes: an updated meta-analysis of randomized controlled trials.International journal of physiology, pathophysiology and pharmacology · 2025Review
- Emerging Preventive Strategies in Chronic Kidney Disease: Recent Evidence and Gaps in Knowledge.Current atherosclerosis reports · 2023Review
- Effect of Antidiabetic Drugs on Bone Health in Patients with Normal Renal Function and in Chronic Kidney Disease (CKD): Insight into Clinical Challenges in the Treatment of Type 2 Diabetes.Journal of clinical medicine · 2023Review
- Effects of Incretin Therapy on Skeletal Health in Type 2 Diabetes-A Systematic Review.JBMR plus · 2023Review
- Adverse events with quetiapine and clarithromycin coprescription: A population-based retrospective cohort study.Health science reports · 2023Article
- To do one and to get more: Part II. Diabetes and metabolic dysfunction-associated fatty liver diseases.Journal of the Chinese Medical Association : JCMA · 2022Review
- To do one and to get more: Part I. Diabetes and bone.Journal of the Chinese Medical Association : JCMA · 2022Review
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
objectivesSodium-glucose cotransporter-2 (SGLT2) inhibitors have been associated with a higher risk of skeletal fractures in some randomized, placebo-controlled trials. Secondary hyperparathyroidism and increased bone turnover (also common in CKD) may contribute to the observed fracture risk. We aimed to determine if SGLT2 inhibitor use associates with a higher risk of fractures compared with dipeptidyl peptidase-4 (DPP-4) inhibitors, which have no known association with fracture risk. We hypothesized that this risk, if present, would be greatest in patients with lower eGFR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a population-based cohort study in Ontario, Canada between 2015 and 2019 using linked provincial administrative data to compare the incidence of fracture between new users of SGLT2 inhibitors and DPP-4 inhibitors. We used inverse probability of treatment weighting on the basis of propensity scores to balance the two groups of older adults (≥66 years of age) on indicators of baseline health. We compared the 180- and 365-day cumulative incidence rates of fracture between groups. Prespecified subgroup analyses were conducted by eGFR category (≥90, 60 to <90, 45 to <60, and 30 to <45 ml/min per 1.73 m
resultsAfter weighting, we identified a total of 38,994 new users of a SGLT2 inhibitor and 37,449 new users of a DPP-4 inhibitor and observed a total of 342 fractures at 180 days and 689 fractures at 365 days. The weighted 180- and 365-day risks of a fragility fracture did not significantly differ between new users of a SGLT2 inhibitor versus a DPP-4 inhibitor: weighted hazard ratio, 0.95 (95% confidence interval, 0.79 to 1.13) and weighted hazard ratio, 0.88 (95% confidence interval, 0.88 to 1.00), respectively. There was no observed interaction between fracture risk and eGFR category (
conclusionsIn this cohort study of older adults, starting a SGLT2 inhibitor versus DPP-4 inhibitor was not associated with a higher risk of skeletal fracture, regardless of eGFR.
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