Chongqing Chemical Industry Vocational College, Chongqing, China.
Hospital of the Southwest University of Political Science and Law, Chongqing, China.
Endokrynol Pol. 2021;72(4):319-328. doi: 10.5603/EP.a2021.0031. Epub 2021 May 19.
The effect of incretins including dipeptidyl peptidase 4 inhibitors (DPP4-Is) and glucagon-like peptide1 receptor agonists (GLP1-ras) in the treatment of type 2 diabetes increasing the risk of fracture remains controversial. No meta-analysis has been written to discuss this from the prospective interventional studies. The objective was to evaluate the association between the use of incretins and fracture risk.
Multiple databases were searched for original articles that investigated the relationship between the use of incretin agents and fracture risk, up to December 2019. Trials using the Mantel-Haenszel method to calculate OR and 95% CI were pooled. The multiple sensitivity, heterogeneity, publication bias, and quality were analysed among the studies to evaluate the robustness of results.
The fixed-effects model was used on account of the I² test for heterogeneity (I² = 0.0%). Incretins were not associated with fracture risk [0.97 (95% CI: 0.88-1.08)]. But in the subgroup analysis, when sitagliptin 100 mg per day (OR 0.495, 95% CI: 0.304-0.806) or liraglutide 1.8 mg per day was administered (OR 0.621, 95% CI: 0.413-0.933), it reduced fracture risk. The sensitivity analysis and publication bias prompted the robustness of results.
This meta-analysis suggested that the current use of incretins not only is safe for fracture in type 2 diabetes patients from RCT studies, but also, when sitagliptin 100 mg or liraglutide 1.8 mg per day was administered, it may exhibit protective effects on bone metabolism.
包括二肽基肽酶 4 抑制剂（DPP4-Is）和胰高血糖素样肽 1 受体激动剂（GLP1-ras）在内的肠降血糖素在治疗 2 型糖尿病方面增加骨折风险的效果仍存在争议。没有荟萃分析从前瞻性干预研究来讨论这一点。目的是评估肠降血糖素的使用与骨折风险之间的关系。
对截至 2019 年 12 月调查肠降血糖素制剂与骨折风险之间关系的原始文章进行了多数据库检索。使用 Mantel-Haenszel 方法计算 OR 和 95%CI 的试验被汇总。对研究中的多重敏感性、异质性、发表偏倚和质量进行了分析，以评估结果的稳健性。
基于异质性的 Mantel-Haenszel 检验（I²=0.0%），使用固定效应模型。肠降血糖素与骨折风险无关[0.97（95%CI：0.88-1.08）]。但在亚组分析中，当每天给予西格列汀 100mg（OR 0.495，95%CI：0.304-0.806）或利拉鲁肽 1.8mg 时（OR 0.621，95%CI：0.413-0.933），它降低了骨折风险。敏感性分析和发表偏倚提示结果稳健。
这项荟萃分析表明，从 RCT 研究来看，目前使用肠降血糖素不仅对 2 型糖尿病患者的骨折是安全的，而且当每天给予西格列汀 100mg 或利拉鲁肽 1.8mg 时，它可能对骨代谢具有保护作用。
