The association between SGLT2 inhibitors and new-onset osteoporosis in patients with type 2 diabetes: a population-based longitudinal cohort study
G P Jong, C F ChangAbstract
Background
Clinical trials have shown the cardiovascular protective effect of sodium-glucose cotransporter-2 inhibitor (SGLT2i) and reduced hospitalization for heart failure. However, the association of the use of SGLT2i and incident osteoporosis in patients with type 2 diabetes (T2D) remains unclear.
Purpose
To evaluate the risk of incident osteoporosis with the use of SGLT2i in patients with T2D.
Methods
This is a population-based cohort study utilizing Taiwan’s National Health Insurance Research Database. We employed the Cox proportional hazards model and propensity score matching (PSM) analyses to evaluate the association between SGLT2i use and osteoporosis risk. The osteoporosis risk between groups was estimated using the Kaplan-Meier method (log-rank analyses).
Results
After the 1:2 matching by age, sex, and duration of type 2 diabetes, this cohort study included 309,747 participants in the SGLT2i group and 619,494 participants in the non-SGLT2i group from 2016 to 2022. In the adjusted Cox proportional hazards model, SGLT2i was associated with a 18% reduction in the risk of incident osteoporosis [HR=0.82, 95% confidence interval (CI): 0.79-0.82]. After propensity score 1:1 matching, a total of 274,329 patients in the SGLT2i group and 274,329 in the non-SGLT2i group were included in the analysis. The SGLT2i group was consistently associated with a lower risk of incident osteoporosis (adjusted hazard ratio: 0.83, 95% confidence interval: 0.80–0.86). The results of the Kaplan-Meier curve analysis indicated that individuals who utilized SGLT2i had a decreased rate of incident osteoporosis (Figures 1 & 2).
Conclusions
In real-world practice, patients with T2D prescribed SGLT2 inhibitors were at lower risk of incident osteoporosis than those not prescribed SGLT2 inhibitors.The Kaplan-Meier analysis between groupsThe Kaplan-Meier analysis between groups