Glucagon-like peptide-1 receptor agonists and risk of bone fracture in patients with type 2 diabetes: A meta-analysis of randomized controlled trials
Glucagon-like peptide-1 receptor agonists and risk of bone fracture in patients with type 2 diabetes: A meta-analysis of randomized controlled trials
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DOI：
10.1002/dmrr.3168
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发表时间：
2019-10-01
影响因子：
8
通讯作者：
Mao, Xiao-Ming
中科院分区：
文献类型：
--
作者：
Cheng, Liang;Hu, Yun;Mao, Xiao-Ming
目的探讨胰高血糖素样肽-1受体激动剂（GLP-1 RAs）与2型糖尿病（T2DM）患者骨折风险的关系。材料和方法我们在PubMed、Embase、Cochrane图书馆和Web of Science中进行了系统的文献检索，检索时间为2018年2月28日，并确定了符合条件的随机对照试验。从每项研究中提取以下数据：第一作者、发表年份、样本量、患者特征、研究设计、干预药物、对照药物、随访时间和骨折事件。采用Review Manager 5.3软件进行meta分析，计算二分类变量的比值比（OR）和95%置信区间（CI）。结果共纳入38项研究，39795例T2DM患者。共发生骨折241例（GLP-1 RAs组107例，对照组134例）。与接受安慰剂和其他抗糖尿病药物治疗的患者相比，接受GLP-1 RAs治疗的患者骨折的合并OR为0.71 （95% CI, 0.56-0.91）。亚组分析显示，利拉鲁肽和利昔那肽治疗与骨折风险显著降低相关（or, 0.56; 95% CI, 0.38-0.81和0.55;95% CI, 0.31-0.97）。然而，其他GLP-1 RAs并没有表现出安慰剂或其他降糖药物的优势。此外，这些有益效果依赖于GLP-1 RAs治疗的持续时间，只有GLP-1 RAs治疗超过52周才能显著降低T2DM患者骨折的风险（OR, 0.71; 95% CI, 0.56-0.91）。结论与安慰剂和其他抗糖尿病药物相比，利拉鲁肽和利昔那肽可显著降低骨折风险，其有益效果与治疗时间有关。
Aims To evaluate the association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and the risk of bone fracture in patients with type 2 diabetes mellitus (T2DM). Materials and methods We conducted a systematic literature search in PubMed, Embase, the Cochrane Library, and Web of Science from inception to 28 February 2018 and identified eligible randomized controlled trials. The following data were extracted from each study: first author, year of publication, sample size, patient characteristics, study design, intervention drug, control drug, follow-up time, and incident bone fracture events. A meta-analysis was conducted using Review Manager 5.3 software to calculate the odds ratio (OR) and 95% confidence intervals (CI) for dichotomous variables. Results A total of 38 studies with 39 795 patients with T2DM were included. There were 241 incident bone fracture cases (107 in the GLP-1 RAs group and 134 in the control group). Compared with patients who received placebo and other anti-diabetic drugs, those who received GLP-1 RAs treatment showed a pooled OR of 0.71 (95% CI, 0.56-0.91) for bone fracture. Subgroup analysis showed that treatments with liraglutide and lixisenatide were associated with significantly reduced risk of bone fractures (ORs, 0.56; 95% CI, 0.38-0.81 and 0.55; 95% CI, 0.31-0.97, respectively). However, other GLP-1 RAs did not show superiority to placebo or other anti-diabetic drugs. Moreover, these beneficial effects were dependent on the duration of GLP-1 RAs treatment, only a GLP-1 RAs treatment period of more than 52 weeks could significantly lower the risk of bone fracture in patients with T2DM (OR, 0.71; 95% CI, 0.56-0.91). Conclusions Compared with placebo and other anti-diabetic drugs, liraglutide and lixisenatide were associated with a significant reduction in the risk of bone fractures, and the beneficial effects were dependent on the duration of treatment.