Effects of SGLT2 inhibitors on fractures and bone mineral density in type 2 diabetes: An updated meta-analysis
Effects of SGLT2 inhibitors on fractures and bone mineral density in type 2 diabetes: An updated meta-analysis
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DOI：
10.1002/dmrr.3170
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发表时间：
2019-10-01
影响因子：
8
通讯作者：
Chen, Liming
中科院分区：
文献类型：
--
作者：
Li, Xiaoyu;Li, Ting;Chen, Liming
背景：本研究的目的是更新和确定葡萄糖转运蛋白2钠(SGLT2)抑制剂治疗对2型糖尿病(T2 DM)患者骨折和骨密度(BMD)的影响。方法我们确定了27个符合条件的随机对照试验(RCT)，这些试验在20895名T2 DM参与者中比较SGLT2抑制剂和安慰剂的有效性和安全性，平均持续时间为64.22周。测定骨折的相对危险度(RR)和骨密度较基线变化的加权平均差(WMD)以评估骨折的危险性。异质性程度通过I-2统计量进行评估，发表偏倚通过漏斗图和Egger检验进行评估。结果合并RR为1.02(95%CI[0.81，1.28])，异质性低，提示SGLT2抑制剂治疗与较高的骨折风险无关。此外，不同年龄、性别、糖化血红蛋白水平和一些生化指标的患者没有发现风险增加。三项涉及1303名患者的试验报告称，骨密度较基线发生了变化。SGLT2抑制剂治疗不降低腰椎、股骨颈、全髋关节和前臂远端四个骨骼部位的骨密度，总体骨密度为0.08(95%CI[-0.09，0.26])。未检测到显著的发表偏倚。结论在这项荟萃分析中，未发现接受SGLT2抑制剂治疗的T2 DM患者发生骨折的风险增加。SGLT2抑制剂治疗似乎没有影响骨骼健康，但需要更长期的详细数据来验证这一结论。
Background The aim of the study is to update and determine the effects of sodium glucose cotransporter 2 (SGLT2) inhibitor therapy on fracture and bone mineral density (BMD) in patients with type 2 diabetes mellitus (T2DM). Methods We identified 27 eligible randomized controlled trials (RCTs) that compared the efficacy and safety of SGLT2 inhibitors to a placebo in 20 895 T2DM participants, with an average duration of 64.22 weeks. The relative risk (RR) of bone fracture and weighted mean difference (WMD) of changes in the BMD from baseline were determined to evaluate the risk of fracture. The degree of heterogeneity was evaluated by the I-2 statistic, and publication bias was estimated using a funnel plot and Egger test. Results The pooled RR was 1.02 (95% CI [0.81, 1.28]) with low heterogeneity, indicating that SGLT2 inhibitor treatment was not correlated with a higher risk of fracture. Additionally, no increased risk was found for patients with different ages, sexes, and levels of HbA1c and some biochemical indicators. Three trials with 1303 patients reported a change in the BMD from baseline. SGLT2 inhibitor treatment did not decrease the BMD at four skeletal sites (lumbar spine, femoral neck, total hip, and distal forearm), and the overall WMD was 0.08 (95% CI [-0.09, 0.26]). No significant publication bias was detected. Conclusions No increased risk for bone fracture was detected in patients with T2DM treated with SGLT2 inhibitors in this meta-analysis. SGLT2 inhibitor therapy did not appear to affect bone health, but more long-term detailed data are needed to validate this conclusion.