Section of Geriatric Cardiology and Medicine, Department of Cardiovascular Medicine, Careggi Teaching Hospital, Florence, Italy.
Diabetes Care. 2011 Nov;34(11):2474-6. doi: 10.2337/dc11-1099.
Thiazolidinediones and insulin are associated with a higher risk of fractures in type 2 diabetic patients. Incretin hormones increase bone density in experimental models, but the effect of dipeptidyl peptidase-4 (DPP-4) inhibitors on bone fractures has not been reported so far.
A meta-analysis was performed including all randomized clinical trials with a duration of at least 24 weeks, enrolling patients with type 2 diabetes, comparing DPP-4 inhibitors with placebo or active drugs.
Twenty-eight trials enrolling 11,880 and 9,175 patients for DPP-4 inhibitors and comparators, respectively, were included, reporting 63 fractures. DPP-4 inhibitors, compared with placebo or other treatments, were associated with a reduced risk of fractures (Mantel-Haenszel odds ratio [MH-OR] 0.60, 95% CI 0.37-0.99, P = 0.045), even after the exclusion of comparisons with thiazolidinediones or sulfonylureas (MH-OR 0.56, 0.33-0.93, P = 0.026).
The present meta-analysis suggests that treatment with DPP-4 inhibitors could be associated with a reduced risk of bone fractures.
噻唑烷二酮类药物和胰岛素与 2 型糖尿病患者骨折风险增加相关。在实验模型中，肠降血糖素会增加骨密度，但到目前为止，还没有关于二肽基肽酶-4（DPP-4）抑制剂对骨折影响的报道。
对所有持续时间至少 24 周的、纳入 2 型糖尿病患者的随机临床试验进行荟萃分析，比较 DPP-4 抑制剂与安慰剂或活性药物。
纳入了 28 项试验，分别纳入了 11880 例和 9175 例接受 DPP-4 抑制剂和对照药物治疗的患者，报告了 63 例骨折。与安慰剂或其他治疗相比，DPP-4 抑制剂与骨折风险降低相关（Mantel-Haenszel 优势比 [MH-OR] 0.60，95%CI 0.37-0.99，P=0.045），甚至在排除与噻唑烷二酮类药物或磺酰脲类药物的比较后（MH-OR 0.56，0.33-0.93，P=0.026）也是如此。
本荟萃分析表明，DPP-4 抑制剂治疗可能与降低骨折风险相关。
