College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea.
Department of Statistics, College of Natural Sciences, Kyungpook National University, Daegu, Republic of Korea.
Osteoporos Int. 2021 Sep;32(9):1705-1712. doi: 10.1007/s00198-020-05801-6. Epub 2021 Feb 16.
The population-based cohort study used the Korean National Health Insurance claims database to evaluate the effect of anti-diabetic drugs on osteoporosis. The use of DPP-IV inhibitors does not increase the risk of osteoporosis compared with the use of sulfonylureas in patients with type 2 diabetes mellitus, while a weak association was found between thiazolidinediones and increased risk of osteoporosis.
The current study aimed to evaluate the effect of dipeptidyl peptidase IV inhibitors (DPP-IVi), thiazolidinedione (TZD), and sulfonylurea (SU) on osteoporosis in patients with type 2 diabetes.
A population-based cohort study was conducted in the Republic of Korea using the Korean National Health Insurance claims database. Data from 2012 to 2017 for patients of 50-99 years of age who were prescribed DPP-IVi, TZD, or SU during 2013-2015 were extracted from the database. Based on pre-defined criteria, a total of 381,404 patients were analyzed after inverse probability of treatment weighting. The association between the study drugs and osteoporosis was estimated using Cox proportional hazards models. Data of 220,166 patients who were prescribed DPP-IVi, 18,630 who were prescribed TZD, and 142,608 patients who were prescribed SU were set.
In the multivariate-adjusted analysis, the hazard ratio (HR) of osteoporosis in the DPP-IVi group was not significantly different from that of the SU group (HR: 0.97; 95% confidence interval (CI) 0.94-1.00), whereas the HR of osteoporosis in the TZD group was higher (HR: 1.13; 95% CI 1.06-1.20). In the subgroup analysis, the HRs of osteoporosis were higher with pioglitazone (HR: 1.14; 95% CI 1.06-1.23) in the TZD group and with glibenclamides (HR: 1.39; 95% CI 1.09-1.77) in the SU group, whereas drugs with lower HR in the DPP-IVi group were saxagliptin (HR: 0.93; 95% CI 0.87-0.99) and sitagliptin (HR: 0.93; 95% CI 0.89-0.97).
DPP-IV inhibitors do not increase the risk of osteoporosis compared with sulfonylureas in patients with type 2 diabetes mellitus, while a weak association was found between thiazolidinediones and increased risk of osteoporosis.
本研究旨在评估二肽基肽酶 4 抑制剂（DPP-4i）、噻唑烷二酮（TZD）和磺酰脲（SU）对 2 型糖尿病患者骨质疏松症的影响。
本研究采用韩国国民健康保险索赔数据库，进行了一项基于人群的队列研究。从数据库中提取了 2012 年至 2017 年 50-99 岁患者的 2013-2015 年期间开具的 DPP-4i、TZD 或 SU 的数据。根据预先定义的标准，对经过逆概率治疗加权后共有 381404 名患者进行了分析。使用 Cox 比例风险模型估计研究药物与骨质疏松症之间的关联。共设定了 220166 例患者服用 DPP-4i、18630 例患者服用 TZD 和 142608 例患者服用 SU。
在多变量调整分析中，DPP-4i 组骨质疏松症的风险比（HR）与 SU 组无显著差异（HR：0.97；95%置信区间（CI）0.94-1.00），而 TZD 组骨质疏松症的 HR 较高（HR：1.13；95% CI 1.06-1.20）。在亚组分析中，TZD 组中吡格列酮（HR：1.14；95% CI 1.06-1.23）和 SU 组中格列本脲（HR：1.39；95% CI 1.09-1.77）的骨质疏松症 HR 较高，而 DPP-4i 组中 HR 较低的药物为沙格列汀（HR：0.93；95% CI 0.87-0.99）和西格列汀（HR：0.93；95% CI 0.89-0.97）。
与 2 型糖尿病患者使用磺酰脲类药物相比，DPP-4 抑制剂不会增加骨质疏松症的风险，而噻唑烷二酮类药物与骨质疏松症风险增加之间存在弱关联。
