Abstract
Diabetes has recently emerged as an independent risk factor for osteoporosis and osteoporotic fractures, and the underlying mechanisms are starting to be unveiled. Medications used in the treatment of diabetes may impact skeletal health in part through glycemic control. In addition, specific classes of anti-hyperglycemic medications directly influence bone metabolism. In particular, thiazolidinedione use is clearly associated with greater fracture risk. Preliminary studies suggest that medications that enhance the incretin effect (GLP-1 receptor analogs and DPP-4 inhibitors) could have a bone-protective effect, whereas SGLT-2 inhibitors could increase fracture risk. This manuscript reviews the impact of anti-hyperglycemic medications on bone health.
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