Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Front Endocrinol (Lausanne). 2022 Jul 7;13:918350. doi: 10.3389/fendo.2022.918350. eCollection 2022.
Type 2 diabetes mellitus (T2DM) is a risk factor for osteoporosis. The effects of T2DM and anti-diabetic agents on bone and mineral metabolism have been observed. Sodium-glucose co-transporter 2 inhibitors (SGLT-2is) promote urinary glucose excretion, reduce blood glucose level, and improve the cardiovascular and diabetic nephropathy outcomes. In this review, we focused on the extraglycemic effect and physiological regulation of SGLT-2is on bone and mineral metabolism. SGLT-2is affect the bone turnover, microarchitecture, and bone strength indirectly. Clinical evidence of a meta-analysis showed that SGLT-2is might not increase the risk of bone fracture. The effect of SGLT-2is on bone fracture is controversial, and further investigation from a real-world study is needed. Based on its significant benefit on cardiovascular and chronic kidney disease (CKD) outcomes, SGLT-2is are an outstanding choice. Bone mineral density (BMD) and fracture risk evaluation should be considered for patients with a high risk of bone fracture.
2 型糖尿病（T2DM）是骨质疏松症的一个危险因素。已经观察到 T2DM 和抗糖尿病药物对骨骼和矿物质代谢的影响。钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2is）促进尿糖排泄，降低血糖水平，并改善心血管和糖尿病肾病结局。在这篇综述中，我们重点关注 SGLT-2is 的血糖外作用及其对骨骼和矿物质代谢的生理调节。SGLT-2is 间接影响骨转换、微结构和骨强度。荟萃分析的临床证据表明，SGLT-2is 可能不会增加骨折风险。SGLT-2is 对骨折的影响存在争议，需要来自真实世界研究的进一步调查。鉴于其对心血管和慢性肾脏病（CKD）结局的显著益处，SGLT-2is 是一个杰出的选择。对于骨折风险高的患者，应考虑骨矿物质密度（BMD）和骨折风险评估。
