Canagliflozin Does Not Increase Fracture Risk

Middle-aged type 2 diabetes patients with a low risk for fracture did not increase their risk when taking canagliflozin compared to a glucagon-like peptide-1 (GLP-1) agonist in a recent study.

Researchers queried two U.S. commercial health care databases to collect data on more than 70 million patients between March 2013 and October 2015. They matched 79,964 patients initiating canagliflozin to 79,964 patients initiating a GLP-1 agonist. Patients were 52% male with a mean age of 55 years. Mean hemoglobin A1c level was 8.7% at baseline, and just over a quarter (27%) of patients were receiving insulin. The study’s composite end point was a fracture of the humerus, forearm, pelvis, or hip. Other fractures were considered secondary outcomes.

Primary outcome rates were similar for canagliflozin (2.2 events per 1,000 person-years) and GLP-1 agonists (2.3 events per 1,000 person-years) (overall hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.75 to 1.26). Both groups also had similar risk for pelvic, hip, humerus, radius, ulna, carpal, metacarpal, metatarsal, or ankle fracture (canagliflozin: 14.5 events per 1,000 person-years. GLP-1 agonists: 16.1 events per 1,000 person-years, overall HR: 0.92, CI: 0.83 to 1.02).

Canagliflozin is a sodium-glucose cotransporter-2 (SGLT2), which in previous studies has been shown to impact bone mineral density, therefore increasing fracture risk. However, in numerous analyses in the present study, researchers found no increased risk for fracture as a result of canagliflozin.

The study authors wrote, “In this study of middle-aged patients with type 2 diabetes and relatively low fracture risk, canagliflozin was not associated with increased risk for fracture compared with GLP-1 agonists.”

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Source: Annals of Internal Medicine