在晚期2型糖尿病患者中，二甲双胍的依从性与较低的骨质疏松性骨折风险相关。

Metformin adherence is associated with lower risk of osteoporotic fracture among patients with advanced type 2 diabetes.

作者信息

Chen Chien-Lung, Hsu Shun-Neng, Chien Li-Nien

机构信息

Taipei Hospital, Ministry of Health and Welfare, No. 127 Siyuan Rd., Xinzhuang Dist., New Taipei City 242033, Taiwan, ROC; Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, No. 155 Sec. 2 Linong St., Beitou Dist., Taipei City 112304, Taiwan, ROC.

Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325 Sec. 2 Chenggong Rd., Neihu District, Taipei City 114202, Taiwan, ROC.

出版信息

Diabetes Res Clin Pract. 2025 Jul;225:112216. doi: 10.1016/j.diabres.2025.112216. Epub 2025 May 14.

DOI:10.1016/j.diabres.2025.112216

PMID:40378961

Abstract

AIMS

To evaluate whether adherence to concurrent metformin (MET) therapy is associated with a reduced risk of fractures among patients with type 2 diabetes mellitus (T2DM).

METHODS

This retrospective cohort study used Taiwan's nationwide claims data from 2014 to 2020 to identify patients aged ≥50 years with T2DM who initiated second-line oral antidiabetic therapy while continuing MET. Patients with a prior history of fractures were excluded. MET adherence was defined as a medication possession ratio >40 % and a refill gap ≤90 days. Fractures were identified through inpatient and outpatient claims using specific diagnosis and procedure codes related to fracture treatment and surgical intervention. Propensity score matching (1:1) was used to balance baseline characteristics, and competing risk regression was applied to estimate fracture risk, accounting for the competing risk of death.

RESULTS

A total of 76,022 patients were included (38,011 per group). MET adherence was significantly associated with a reduced risk of all-site fractures (adjusted subdistribution hazard ratio[aSHR] = 0.76; 95 % CI: 0.69-0.83; P < 0.001), with consistent effects across fracture sites. No additional benefit was observed with concurrent use of DPP4i or SGLT2i.

CONCLUSIONS

MET adherence was associated with lower fracture risk in older adults with T2DM, highlighting its potential role in fracture prevention.

摘要

目的

评估2型糖尿病（T2DM）患者坚持同时使用二甲双胍（MET）治疗是否与骨折风险降低相关。

方法

这项回顾性队列研究使用了台湾2014年至2020年的全国性索赔数据，以确定年龄≥50岁且在继续使用MET的同时开始二线口服抗糖尿病治疗的T2DM患者。排除有骨折病史的患者。MET依从性定义为药物持有率>40%且再填充间隔≤90天。通过使用与骨折治疗和手术干预相关的特定诊断和程序代码的住院和门诊索赔来识别骨折。倾向评分匹配（1:1）用于平衡基线特征，并应用竞争风险回归来估计骨折风险，同时考虑死亡的竞争风险。

结果

共纳入76,022例患者（每组38,011例）。MET依从性与所有部位骨折风险降低显著相关（调整后的亚分布风险比[aSHR]=0.76；95%CI：0.69-0.83；P<0.001），在各骨折部位效果一致。同时使用二肽基肽酶4抑制剂（DPP4i）或钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）未观察到额外益处。