Zhanjiang Key Laboratory of Orthopaedic Technology and Trauma Treatment, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, China.
Guangdong Provincial Key Laboratory for Research and Development of Natural Drug, School of Pharmacy, Guangdong Medical University, Zhanjiang, China.
Front Endocrinol (Lausanne). 2023 Jan 11;13:1038603. doi: 10.3389/fendo.2022.1038603. eCollection 2022.
Increasing evidence suggests that metformin can affect bone metabolism beyond its hypoglycemic effects in diabetic patients. However, the effects of metformin on fracture risk in type 2 diabetes mellitus (T2DM) patients remain unclear. A systematic review and meta-analysis were performed in this study to evaluate the association between metformin application and fracture risk in T2DM patients based on previous studies published until June 2021.
A systematic search was performed to collect publications on metformin application in T2DM patients based on PubMed, Embase, Cochran, and Web of Science databases. Meta-analysis was performed by using a random-effects model to estimate the summary relative risks (RRs) with 95% confidence intervals (CIs). Subgroup analyses based on cohort/case-control and ethnicity and sensitivity analyses were also performed.
Eleven studies were included in the meta-analysis. Results demonstrated metformin use was not significantly associated with a decreased risk of fracture (RR, 0.91; 95% CI, 0.81-1.02; I 96.8%). Moreover, metformin use also demonstrated similar results in subgroup analyses of seven cohort studies and four case-control studies, respectively (RR, 0.90; 95% CI, 0.76-1.07; I 98.0%; RR, 0.96; 96% CI, 0.89-1.03; I 53.7%). Sensitivity analysis revealed that there was no publication bias.
There was no significant correlation between fracture risk and metformin application in T2DM patients. Due to a limited number of existing studies, further research is needed to make a definite conclusion for clinical consensus.
越来越多的证据表明，二甲双胍除了具有降血糖作用外，还能影响糖尿病患者的骨代谢。然而，二甲双胍对 2 型糖尿病（T2DM）患者骨折风险的影响尚不清楚。本研究通过对截至 2021 年 6 月发表的研究进行系统评价和荟萃分析，评估了 T2DM 患者中应用二甲双胍与骨折风险之间的关联。
系统检索 PubMed、Embase、Cochran 和 Web of Science 数据库中关于 T2DM 患者应用二甲双胍的文献，采用随机效应模型进行荟萃分析，以估计汇总相对风险（RR）及其 95%置信区间（CI）。还进行了亚组分析，包括队列/病例对照研究和种族亚组分析，并进行了敏感性分析。
共有 11 项研究纳入荟萃分析。结果表明，应用二甲双胍与骨折风险降低无关（RR，0.91；95%CI，0.81-1.02；I 96.8%）。此外，在分别对 7 项队列研究和 4 项病例对照研究的亚组分析中，二甲双胍的应用也得到了类似的结果（RR，0.90；95%CI，0.76-1.07；I 98.0%；RR，0.96；96%CI，0.89-1.03；I 53.7%）。敏感性分析显示不存在发表偏倚。
T2DM 患者骨折风险与二甲双胍应用之间无显著相关性。由于现有研究数量有限，需要进一步研究以达成临床共识。
