Effect of sodium-glucose transporter 2 inhibitors on bone

Abstract

Diabetes mellitus is a common illness, and the number of people affected by this condition is expected to increase significantly. Complications associated with type 2 diabetes mellitus, such as cataracts, retinopathy, neuropathy, and orthostatic hypotension, can increase the risk of falls and subsequent bone fractures. Canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, and ipragliflozin are a group of medications known as sodium-glucose cotransporter-2 inhibitors (SGLT-2i), which are oral drugs used to treat type 2 diabetes mellitus. This group of medications is a recent addition to the current treatment options for this condition. There are concerns about the impact of SGLT-2 inhibitors on bone health. Although drugs in this category have similarities in reducing blood glucose and preventing cardiovascular disease, they can have varying effects on bone metabolism. The effect of SGLT-2 inhibitors (SGLT-2is)-induced weight loss on bone mineral density (BMD) and bone turnover is significant and cannot be disregarded. Although SGLT-2 inhibitors were initially predicted to increase the likelihood of bone fractures, clinical evidence contradicts this assumption. It is noteworthy to emphasize that empagliflozin and dapagliflozin did not indicate an increased risk of fractures. It is also interesting to note that SGLT2i drugs positively affect heart function and can reduce the incidence of heart failure, which can lead to a decrease in osteoporosis and bone fractures. Based on clinical trials and real-world evidence, there does not appear to be a link between the administration of SGLT2 inhibitors and the risk of fractures. However, caution should still be exercised when prescribing these drugs to patients with advanced disease or kidney complications who may be at higher risk of bone fractures. It is always important to consider individual patient factors and potential risks before making treatment decisions.