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Canagliflozin not associated with increased risk for fracture in T2D patients

12 Jan 2019

Use of canagliflozin, compared with a glucagon-like peptide-1 (GLP-1) agonist, does not increase the risk for fracture in middle-aged patients with type 2 diabetes and relatively low fracture risk, according to a recent study.

A total of 79,964 patients (mean age 55 years; 48 percent female; average baseline haemoglobin A1c, 8.7 percent; 27 percent were prescribed insulin) initiating use of canagliflozin were included in this study. They were matched to the same number of patients initiating use of a GLP-1 agonist.

The rate of humerus, forearm, pelvis or hip fracture that needed intervention was comparable among patients in the canagliflozin (2.2 events per 1,000 person-years) and GLP-1 agonist groups (2.3 events per 1,000 person-years; overall hazard ratio [HR], 0.98; 95 percent CI, 0.75–1.26).

There was also comparable risk for pelvic, hip, humerus, radius, ulna, carpal, metacarpal, metatarsal or ankle fracture between canagliflozin (14.5 events per 1,000 person-years) and GLP-1 agonist groups (16.1 events per 1,000 person-years; overall HR, 0.92; 0.83–1.02).

In this population-based new-user cohort study, the authors estimated risk for nonvertebral fracture among new users of canagliflozin vs GLP-1 agonist. Two US commercial healthcare databases providing data on >70 million patients were accessed from March 2013 to October 2015.

The primary outcome was a composite of humerus, forearm, pelvis, or hip fracture requiring intervention, while secondary outcomes included fractures at other sites. The authors performed a fixed-effects meta-analysis that pooled results from the databases to provide an overall HR.

The study was limited by unmeasured confounding, measurement error and low fracture rate.

“Sodium–glucose cotransporter-2 inhibitors promote glycosuria, resulting in possible effects on calcium, phosphate, and vitamin D homeostasis. Canagliflozin is associated with decreased bone mineral density and a potential increased risk for fracture,” the authors noted.

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Most Read Articles
Pearl Toh, 5 days ago
A latest study at ISC 2019 shows that even patients with large-core stroke damage can have a good outcome after mechanical clot removal with endovascular thrombectomy (EVT), depending on the size of the infarct and time lapses between stroke onset and treatment.
Stephen Padilla, 06 Feb 2019
Alirocumab has prevented nonfatal cardiovascular events and deaths, the total of which is twice the number of first events prevented among patients with acute coronary syndrome (ACS) over a median follow-up of 2.8 years, according to results of the ODYSSEY OUTCOMES* trial. In addition, a robust association is seen between the risks of nonfatal and fatal events during the study.
14 Sep 2017
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13 Dec 2018
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