Canagliflozin not associated with increased risk for fracture in T2D patients
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.