| アブストラクト | AIMS: Mixed evidence exists for the effect of incretin-based therapies on osteoporosis in type-2 diabetes. Therefore, we conducted a cohort study to determine the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and common osteoporotic "fragility fractures" (upper extremity, hip, spine). METHODS: The UK-based Clinical Practice Research Datalink was used to identify adults without prior fractures receiving a new anti-diabetic drug or a new type-2 diabetes diagnosis between 2007 and 2016. The primary aim was to compare new-users of DPP-4 inhibitors versus new-users of sulfonylureas (SU). The association between DPP-4 inhibitors and incident fractures was estimated using Cox proportional hazards models. Deciles of high-dimensional propensity scores and other anti-diabetic drugs were used as covariates. RESULTS: We identified 7993 and 26,636 new-users of DPP-4 inhibitors and SUs, respectively. At cohort entry, the mean age was 58.8, 40% were female, mean diabetes duration was 1.3years, and 42% had A1c>9%. Over 9years (mean follow-up=1.2years), the incident rate of fragility fractures was lower among DPP-4 versus SU users (3.0/1000 vs. 5.2/1000 person-years; P-value=0.007). After adjustment, there was no statistically significant difference in fracture risk (hazard ratio adjusted, aHR=0.80, 95%CI 0.51-1.24; P-value=0.3125). In a secondary analysis, DPP-4 inhibitors were not associated with a difference in fracture risk compared to insulin (aHR=0.91, 95%CI 0.40-2.09); however were associated with a lower fracture risk versus thiazolidinediones (aHR=0.47, 95%CI 0.26-0.83). Sensitivity analyses supported findings. CONCLUSIONS: DPP-4 inhibitors are not associated with an increased risk of fragility fractures compared with SUs or insulin; however, are associated with a lower risk versus thiazolidinediones. |
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| ジャーナル名 | Diabetes research and clinical practice |
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| 投稿日 | 2017/12/21 |
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| 投稿者 | Gamble, John-Michael; Donnan, Jennifer R; Chibrikov, Eugene; Twells, Laurie K; Midodzi, William K; Majumdar, Sumit R |
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| 組織名 | School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada; School of;Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada.;Electronic address: jm.gamble@uwaterloo.ca.;School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador,;Canada.;Canada; Faculty of Medicine, Memorial University, St. John's, Newfoundland and;Labrador, Canada.;Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador,;Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/29258886/ |
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