April 27, 2016

SGLT2 Therapy Does Not Prevent Diabetic Bone Disease

And yet another problem with SGLT2 diabetes drugs. Doctors are being told to take bone density and history of osteoporosis into consideration when prescribing SGLT2 inhibitors. Both type 1 and 2 diabetes patients are at increased risk of bone fractures.

It is believed that the cause is the chronic hyperglycemia state that leads to a decrease in bone density, and this in turn puts diabetes patients at risk for osteopenia and osteoporosis. Osteopenia is a condition of bone in which decreased calcification, decreased density, or reduced mass occurs. Therefore, bone microarchitecture and strength could be potentially amplified by down-regulating patients’ blood glucose levels.

Using sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors), seems to lower blood glucose levels only by 0.7 to 1.0 percent which is helpful but not great in the overall blood glucose lowering needs. They work by blocking sodium-glucose cotransporter 2 in the proximal tubules of the kidneys and reducing the reabsorption of filtered glucose from the tubular lumen, which lowers glucose levels in the blood. The added benefit of this group of medications is a slight weight loss.

Paradoxically, previous studies indicated that treatment with the SGLT2 inhibitor canagliflozin could actually worsen the bone structure and increase the risk for bone fractures by 30%.

While recent studies have all be on rodents, the findings do suggest an association between the increased risk for bone fractures and using medications like canagliflozin, and caution in using them in a group of patient at high risk for bone fracture.

Because of the rodent studies, we definitely need more studies that involve human participants who would challenge these findings. The significance of the results may increase since, currently, SGLT2 inhibitors are approved by the FDA only for type 2 diabetes patients, but it may change as new studies are being conducted on type 1 patients.

Doctors are being advised that SGLT2 inhibitors can contribute to increased risk of bone fractures in diabetes patients. In diabetes patients with a history of multiple bone fractures or osteoporosis, it may be wise to stay away from SGLT2 inhibitors and try other groups of medications first. Physicians are encouraged to report any known incidents of sudden unexpected worsening of bone density in patients who recently got started on SGLT2 inhibitor therapy.

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