胰高血糖素样肽-1 受体激动剂与 2 型糖尿病患者骨折风险：一项随机对照试验的荟萃分析。

Glucagon-like peptide-1 receptor agonists and risk of bone fracture in patients with type 2 diabetes: A meta-analysis of randomized controlled trials.

机构信息

Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.

Department of Endocrinology, Huai'an Second People's Hospital, Huai'an, China.

出版信息

Diabetes Metab Res Rev. 2019 Oct;35(7):e3168. doi: 10.1002/dmrr.3168. Epub 2019 May 6.

DOI:10.1002/dmrr.3168

PMID:30974033

Abstract

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.

摘要

目的

评估胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）与 2 型糖尿病（T2DM）患者骨折风险之间的关系。

材料与方法

我们在 PubMed、Embase、Cochrane 图书馆和 Web of Science 中进行了系统的文献检索，检索时间从建库至 2018 年 2 月 28 日，纳入了合格的随机对照试验。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。使用 Review Manager 5.3 软件进行荟萃分析，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，包含 39795 例 T2DM 患者。共有 241 例骨折事件（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的患者相比，接受 GLP-1 RAs 治疗的患者骨折的汇总 OR 为 0.71（95%CI，0.56-0.91）。亚组分析显示，利拉鲁肽和利西那肽治疗与骨折风险显著降低相关（ORs，0.56；95%CI，0.38-0.81 和 0.55；95%CI，0.31-0.97）。然而，其他 GLP-1 RAs 与安慰剂或其他抗糖尿病药物相比并没有优势。此外，这些有益作用取决于 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 患者的骨折风险（OR，0.71；95%CI，0.56-0.91）。