2型糖尿病患者使用胰高血糖素样肽-1受体激动剂与骨折风险的关联：一项随机对照试验的荟萃分析
Association of Glucagon-like peptide-1 receptor agonists use with fracture risk in type 2 diabetes: A meta-analysis of randomized controlled trials.
作者信息
Zhang Yuan, Chen Guanhua, Wang Weimin, Yang Donghui, Zhu Dalong, Jing Yali
机构信息
Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China; Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
出版信息
Bone. 2025 Mar;192:117338. doi: 10.1016/j.bone.2024.117338. Epub 2024 Nov 26.
BACKGROUND
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of osteoporosis (OP) and fractures.
PURPOSE
The aim of this study was to analyze the available evidence on the effect of GLP-1 RAs on fracture risk in patients with type 2 diabetes.
METHODS
A systematic search based on PubMed, Embase and Web of Science databases was performed to collect relevant literature published until May 2024 on the application of GLP-1 RAs in T2DM patients. Data were extracted from each study for comparative analysis, and meta-analysis was performed using R software to calculate relative risk (RR) and 95 % confidence intervals (CI) for dichotomous variables. Two subgroup analyses were also performed.
RESULTS
A total of 44 randomized controlled trials (RCTs) involving 47,823 patients were analyzed. There were 292 incident fracture cases (138 in GLP-1 RAs group and 154 in control group). The pooled RR for fractures in patients treated with GLP-1RAs compared with those treated with placebo or other anti-diabetic drugs was 0.77 (95 % CI: 0.61-0.96). Subgroup analyses showed that the beneficial effect was dependent on the period of treatment with GLP-1 RAs, only treated for >78 weeks were effective in reducing the risk of fractures in patients with T2DM (RR 0.77; 95 % CI: 0.61-0.96). Furthermore, subgroup analyses showed that liraglutide treatment was associated with a significant reduction in fracture risk (RR 0.42; 95 % CI: 0.21-0.85). However, other GLP-1 RAs did not present benefits over other anti-diabetic drug treatments.
CONCLUSION
GLP-1 RAs could reduce the risk of fracture in T2DM patients, and the beneficial effect was interrelated to the period of treatment. Liraglutide could significantly reduce the risk of fracture in T2DM patients compared to placebo and other anti-diabetic drugs. Due to the limited nature of contemporary research, further studies are needed to develop a clear clinical consensus.
背景
2型糖尿病（T2DM）与骨质疏松症（OP）及骨折风险增加相关。
目的
本研究旨在分析关于胰高血糖素样肽-1受体激动剂（GLP-1 RAs）对2型糖尿病患者骨折风险影响的现有证据。
方法
基于PubMed、Embase和Web of Science数据库进行系统检索，以收集截至２０２４ 年５月发表的有关GLP - 1 RAs在T２DM患者中应用的相关文献。从每项研究提取的数据进行对比分析，并使用R软件进行荟萃分析，计算二分变量的相对风险（RR）和9５％置信区间（CI）。还进行了两项亚组分析。
结果
共分析了涉及47,823例患者的4４项随机对照试验（RCT）。有２９２例新发骨折病例(GLP - 1 RAs组１38例，对照组154例).与接受安慰剂或其他抗糖尿病药物治疗的患者相比，接受GLP - 1 RAs治疗的患者骨折的合并RR为0.77(95％CI:0.61 - 0.96）。亚组分析表明，有益效果取决于GLP - 1 RAs的治疗时间，仅治疗超过78周对降低T2DM患者骨折风险有效（RR 0.77；95％CI：0.61 - 0.96）。此外，亚组分析表明，利拉鲁肽治疗与骨折风险显著降低相关（RR 0.42；95％CI：0.21 - 0.85）。然而，其他GLP - 1 RAs与其他抗糖尿病药物治疗相比并无益处。
结论
GLP - 1 RAs可降低T2DM患者的骨折风险，且有益效果与治疗时间相关。与安慰剂和其他抗糖尿病药物相比，利拉鲁肽可显著降低T2DM患者的骨折风险。由于当代研究的局限性，需要进一步研究以达成明确的临床共识。
Zotero 插件