钠-葡萄糖协同转运蛋白2抑制剂与2型糖尿病患者的骨折风险：一项随机对照试验的荟萃分析
Sodium-glucose cotransporter 2 inhibitors and fracture risk in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials.
作者信息
Lou Yake, Yu Ying, Duan Junchao, Bi Sining, Swe Khaing Nyein Chan, Xi Ziwei, Gao Yanan, Zhou Yujie, Nie Xiaomin, Liu Wei
机构信息
Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Chaoyang District, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
出版信息
Ther Adv Chronic Dis. 2020 Sep 26;11:2040622320961599. doi: 10.1177/2040622320961599. eCollection 2020.
BACKGROUND
Patients with type 2 diabetes mellitus (T2DM) have an increased risk of fracture compared with those without T2DM. Some oral glucose-lowering agents may increase the incidence of fracture. Whether sodium-glucose co-transporter 2 inhibitors (SGLT2is) are associated with increased risk of fracture remains unclear.
METHODS
We retrieved articles from database, and other sources up to 24 October 2019. We included randomized controlled trials (RCTs) that reported fractures and analyzed the fracture incidence of SGLT2i, canagliflozin, dapagliflozin, and empagliflozin. Subgroup analysis was also performed based on baseline characteristics.
RESULTS
A total of 78 RCTs with 85,122 patients were included in our analysis. The overall SGLT2i fracture incidence was 2.56% 2.77% in the control group [odds ratio (OR), 1.03; 95% confidence interval (CI) (0.95, 1.12); = 0.49]. Compared with the control treatment, treatment with canagliflozin led to a higher rate of fractures [OR, 1.17; 95% CI (1.00, 1.37); = 0.05], but no significant difference was observed when compared with dapagliflozin [OR, 1.02; 95% CI (0.90, 1.15); = 0.79] or empagliflozin [OR, 0.89; 95% CI (0.73, 1.10); = 0.30]. Subgroup analysis showed that, in a follow-up of less than 52 weeks, SGLT2i decreased the incidence of fracture by 29% [OR, 0.71; 95% CI (0.55, 0.93); = 0.01], but this benefit was lost when the follow-up extended to more than 52 weeks [OR, 1.08; 95% CI (0.98, 1.18); = 0.12].
CONCLUSION
Canagliflozin seems to increase the risk of fracture, while other SGLT2is do not result in a higher incidence of fracture.
背景
与非2型糖尿病（T2DM）患者相比，T2DM患者骨折风险增加。一些口服降糖药可能会增加骨折发生率。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）是否与骨折风险增加相关尚不清楚。
方法
我们检索了截至2019年10月24日的数据库及其他来源的文章。我们纳入了报告骨折情况的随机对照试验（RCT），并分析了SGLT2i、卡格列净、达格列净和恩格列净的骨折发生率。还根据基线特征进行了亚组分析。
结果
我们的分析共纳入了78项RCT，涉及85122例患者。SGLT2i组的总体骨折发生率为2.56%，对照组为2.77%[比值比（OR），1.03；95%置信区间（CI）（0.95，1.12）；P = 0.49]。与对照治疗相比，卡格列净治疗导致骨折发生率更高[OR，1.17；95%CI（1.00，1.37）；P = 0.05]，但与达格列净[OR，1.02；95%CI（0.90，1.15）；P = 0.79]或恩格列净[OR，0.89；95%CI（0.73，1.10）；P = 0.30]相比，未观察到显著差异。亚组分析显示，在随访时间少于52周时，SGLT2i使骨折发生率降低了29%[OR，0.71；95%CI（0.55，0.93）；P = 0.01]，但当随访延长至超过52周时，这种益处消失了[OR，1.08；95%CI（0.98，1.18）；P = 0.12]。
结论
卡格列净似乎会增加骨折风险，而其他SGLT2i不会导致更高的骨折发生率。
Zotero 插件