Sodium-glucose cotransporter-2 (SGLT2) inhibitors promote glycosuria, resulting in possible effects on calcium, phosphate, and vitamin D homeostasis. Some studies suggest that canagliflozin, an SGLT2 inhibitor, is associated with decreased bone mineral density and a potential increased risk for fracture, which is important because people with type 2 diabetes are already at higher risk. These conflicting study results raise challenges in counseling patients prescribed canagliflozin about the risk for fracture.
Researchers from Brigham and Women's Hospital reviewed two U.S. commercial health care databases providing data on more than 70 million patients from March 2013 to October 2015 to estimate risk for nonvertebral fracture among new users of canagliflozin. Dr Mike Fralick, the study's lead author, indicated that the overall rate of fracture was similarly low among patients with type 2 diabetes who were treated with canagliflozin or a GLP-1 agonist.
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