Dipeptidyl peptidase-4 inhibitors and bone fractures: a meta-analysis of randomized clinical trials

Matteo Monami, Ilaria Dicembrini, Alessandro Antenore, Edoardo Mannucci, Matteo Monami, Ilaria Dicembrini, Alessandro Antenore, Edoardo Mannucci

Abstract

Objective: Thiazolidinediones and insulin are associated with a higher risk of fractures in type 2 diabetic patients. Incretin hormones increase bone density in experimental models, but the effect of dipeptidyl peptidase-4 (DPP-4) inhibitors on bone fractures has not been reported so far.

Research design and methods: A meta-analysis was performed including all randomized clinical trials with a duration of at least 24 weeks, enrolling patients with type 2 diabetes, comparing DPP-4 inhibitors with placebo or active drugs.

Results: Twenty-eight trials enrolling 11,880 and 9,175 patients for DPP-4 inhibitors and comparators, respectively, were included, reporting 63 fractures. DPP-4 inhibitors, compared with placebo or other treatments, were associated with a reduced risk of fractures (Mantel-Haenszel odds ratio [MH-OR] 0.60, 95% CI 0.37-0.99, P = 0.045), even after the exclusion of comparisons with thiazolidinediones or sulfonylureas (MH-OR 0.56, 0.33-0.93, P = 0.026).

Conclusions: The present meta-analysis suggests that treatment with DPP-4 inhibitors could be associated with a reduced risk of bone fractures.

Figures

Figure 1
Figure 1
Subgroup analyses of MH-OR (95% CI) for bone fractures in placebo-controlled trials. DPP-4i, DPP-4 inhibitors.

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