Department of Endocrinology and Metabolism, MAGIC China Centre, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Laboratory of Stem Cell Biology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Diabetes Metab Res Rev. 2024 Feb;40(2):e3780. doi: 10.1002/dmrr.3780.
To assess the time-dependent risk of fracture in adults with type 2 diabetes receiving anti-diabetic drugs.
We searched MEDLINE, EMBASE, and Cochrane Library up to 18 November 2021, for randomized controlled trials (RCTs) and propensity-score-matched non-randomized studies (NRSs) comparing all anti-diabetic drugs with standard treatment or with each other on fracture in adults with type 2 diabetes. The study performed a one-stage network meta-analysis using discrete-time hazard regression with reconstructed individual time-to-event data.
This network meta-analysis involved seven RCTs (65,051 adults with type 2 diabetes) with a median follow-up of 36 months and three propensity-score-based NRSs (17,954 participants) with a median follow-up of 27.3 months. Among anti-diabetic drugs, thiazolidinediones increased the overall hazard of fracture by 42% (95% credible interval [CrI], 3%-97%) and almost tripled the risk after 4 years (hazard ratio [HR], 2.74; 95% CrI, 1.53-4.80). Credible subgroup analysis suggested that thiazolidinediones increased the hazard of fracture only in females (HR, 2.19; 95% CrI, 1.26-3.74) but not among males (HR, 0.81; 95% CrI, 0.45-1.40). Moderate certainty evidence established that thiazolidinediones increase 92 fractures in five years per 1000 female patients. We did not find the risk of fractures with other anti-diabetic drugs including metformin, sulfonylureas, sodium-glucose cotransporter-2 (SGLT2) inhibitors, and dipeptidyl peptidase-4 (DPP-4) inhibitors.
Long-term use of thiazolidinediones elevates the risk of fracture among females with type 2 diabetes. There is no evidence eliciting fracture risk associated with other anti-diabetic drugs.
评估接受抗糖尿病药物治疗的 2 型糖尿病成人骨折的时间依赖性风险。
我们检索了 MEDLINE、EMBASE 和 Cochrane Library，截至 2021 年 11 月 18 日，以比较所有抗糖尿病药物与标准治疗或彼此在 2 型糖尿病成人中的骨折风险的随机对照试验（RCT）和倾向评分匹配的非随机研究（NRS）。该研究使用离散时间风险回归和重建的个体事件时间数据进行了一阶网络荟萃分析。
这项网络荟萃分析涉及 7 项 RCT（65051 例 2 型糖尿病成人），中位随访时间为 36 个月，3 项基于倾向评分的 NRS（17954 名参与者），中位随访时间为 27.3 个月。在抗糖尿病药物中，噻唑烷二酮类药物使骨折的总体风险增加了 42%（95%可信区间[CrI]，3%-97%），并且在 4 年后风险几乎增加了两倍（风险比[HR]，2.74；95%CrI，1.53-4.80）。可信亚组分析表明，噻唑烷二酮类药物仅增加了女性骨折的风险（HR，2.19；95%CrI，1.26-3.74），而不是男性（HR，0.81；95%CrI，0.45-1.40）。中等确定性证据表明，噻唑烷二酮类药物会使每 1000 名女性患者在五年内增加 92 例骨折。我们没有发现其他抗糖尿病药物（包括二甲双胍、磺酰脲类药物、钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂和二肽基肽酶-4（DPP-4）抑制剂）与骨折风险相关。
长期使用噻唑烷二酮类药物会增加 2 型糖尿病女性骨折的风险。没有证据表明其他抗糖尿病药物与骨折风险相关。
