Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Dec 23;16(1):310.
doi: 10.1186/s13098-024-01518-2.

Hypoglycemic agents and bone health; an umbrella systematic review of the clinical trials' meta-analysis studies

Pouria Khashayar #  1 , Farid Farahani Rad #  2 , Ozra Tabatabaei-Malazy  3   4 , Sara MohammadHosseinzadeh Golabchi  2 , Patricia Khashayar  5 , Mehdi Mohammadi  6 , Sholeh Ebrahimpour  6 , Bagher Larijani  7
Affiliations
Review

Hypoglycemic agents and bone health; an umbrella systematic review of the clinical trials' meta-analysis studies

Pouria Khashayar et al. Diabetol Metab Syndr. .

Abstract

Background: No clear consensus exists regarding the safest anti-diabetic drugs with the least adverse events on bone health. This umbrella systematic review therefore aims to assess the published meta-analysis studies of randomized controlled trials (RCTs) conducted in this field.

Methods: All relevant meta-analysis studies of RCTs assessing the effects of anti-diabetic agents on bone health in patients with diabetes mellitus (DM) were collected in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). English articles published until 15 March 2023 were collected through the search of Cochrane Library, Scopus, ISI Web of Sciences, PubMed, and Embase using the terms "Diabetes mellitus", "anti-diabetic drugs", "Bone biomarker", "Bone fracture, "Bone mineral density" and their equivalents. The methodological and evidence quality assessments were performed for all included studies.

Results: From among 2220 potentially eligible studies, 71 meta-analyses on diabetic patients were included. Sodium-glucose cotransporter-2 inhibitors (SGLT-is) showed no or equivalent effect on the risk of fracture. Dipeptidyl peptidase-4 inhibitors (DPP-4is) and Glucagon-like peptide-1 receptor agonists (GLP-1Ras) were reported to have controversial effects on bone fracture, with some RCTs pointing out the bone protective effects of certain members of these two medication classes. Thiazolidinediones (TZDs) were linked with increased fracture risk as well as higher concentrations of C-terminal telopeptide of type I collagen (CTx), a bone resorption marker.

Conclusion: The present systematic umbrella review observed varied results on the association between the use of anti-diabetic drugs and DM-related fracture risk. The clinical efficacy of various anti-diabetic drugs, therefore, should be weighed against their risks and benefits in each patient.

Keywords: Anti-diabetic agents; Bone biomarkers; Bone fracture; Bone mineral density; Diabetes mellitus.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was granted by Research Ethics Committees of Endocrine & Metabolism Research Institute- Tehran University of Medical Sciences (IR.TUMS.EMRI.REC.1401.155). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of the study review process
See this image and copyright information in PMC

References

    1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183: 109119. 10.1016/j.diabres.2021.109119. - PMC - PubMed
    1. Gilbert MP, Pratley RE. The impact of diabetes and diabetes medications on bone health. Endocr Rev. 2015;36(2):194–213. - PubMed
    1. Wu B, Fu Z, Wang X, Zhou P, Yang Q, Jiang Y, et al. A narrative review of diabetic bone disease: characteristics, pathogenesis, and treatment. Front Endocrinol (Lausanne). 2022;13:1052592. 10.3389/fendo.2022.1052592. - PMC - PubMed
    1. Lee HS, Hwang JS. Impact of type 2 diabetes mellitus and antidiabetic medications on bone metabolism. Curr Diab Rep. 2020;20(12):78. 10.1007/s11892-020-01361-5. - PubMed
    1. Wang F, Zheng L, Theopold J, Schleifenbaum S, Heyde C-E, Osterhoff G. Methods for bone quality assessment in human bone tissue: a systematic review. J Orthop Surg Res. 2022;17(1):174. 10.1186/s13018-022-03041-4. - PMC - PubMed

LinkOut - more resources