Division of Nephrology, Department of Internal Medicine.
Department of Clinical Pharmacology and Pharmacy, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Curr Opin Nephrol Hypertens. 2019 Jul;28(4):321-327. doi: 10.1097/MNH.0000000000000505.
Sodium glucose cotransporter 2 (SGLT2) inhibitors are relatively novel antidiabetic drugs that improve glycemic control and reduce cardiovascular outcomes as well as renal function decline. SGLT2 inhibitors act by inhibiting glucose reabsorption in the proximal tubule of the kidney. Emerging data suggest that these drugs may also influence bone and mineral metabolism. This review summarizes clinical trial data on bone and mineral outcomes, and discusses potential underlying mechanisms.
Three large randomized controlled trials documented cardiovascular and renal protective effects of SGLT2 inhibitors. Recent studies indicate that SGLT2 inhibitors influence renal phosphate reabsorption and calciuria. Although the CANVAS trial suggested an increased fracture risk associated with canagliflozin compared with placebo, the vast majority of trials and meta-analyses did not demonstrate an increased fracture risk associated with SGLT2 inhibitor use.
SGLT2 inhibitors have shown clinically relevant cardiovascular and renal protective effects. The long-term implications for bone health, in particular in the context of chronic kidney disease, are still incompletely understood and warrant further investigation.
钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂是一种新型的降糖药物，可改善血糖控制，减少心血管结局事件，延缓肾功能下降。SGLT2 抑制剂通过抑制肾脏近曲小管对葡萄糖的重吸收起作用。新出现的数据表明，这些药物可能还会影响骨骼和矿物质代谢。本综述总结了 SGLT2 抑制剂对骨骼和矿物质结局的临床试验数据，并讨论了潜在的作用机制。
三项大型随机对照试验记录了 SGLT2 抑制剂的心血管和肾脏保护作用。最近的研究表明，SGLT2 抑制剂会影响肾脏对磷酸盐的重吸收和钙排泄。尽管 CANVAS 试验表明卡格列净与安慰剂相比会增加骨折风险，但绝大多数试验和荟萃分析并未表明 SGLT2 抑制剂的使用会增加骨折风险。
SGLT2 抑制剂具有显著的临床相关心血管和肾脏保护作用。这些药物对骨骼健康的长期影响，尤其是在慢性肾脏病的背景下，仍不完全清楚，需要进一步研究。
