Abstract
This article succinctly summarizes the available evidence on the risk of bone fractures with sodium-glucose co-transporter-2 inhibitors. The US Food and Drug Administration has strengthened the warning for canagliflozin related to the increased risk of bone fractures, and added new information about decreased bone mineral density. The agency has also said that it will evaluate the risk of bone fractures with other drugs in the sodium-glucose co-transporter-2 inhibitor class. Increases in parathyroid hormone levels and decreases in 1,25-dihydroxyvitamin D levels have been postulated as possible mechanisms. In contrast, some studies with dapagliflozin have shown no effects on bone health. Because a consensus has not been reached, we believe that an expert opinion on how to interpret the available evidence would be of great benefit for clinicians.
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Edoardo Mannucci has received consultancy fees from Merck and Novartis, speaking fees from Astra Zeneca, Bristol Myers Squibb, Merck, and Novartis, and research grants from Merck, Novartis, and Takeda. Matteo Monami has received speaking fees from Bristol Myers Squibb, Eli-Lilly, Merck, Novo Nordisk, Merck, and Takeda, and research grants from Bristol Myers Squibb.
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Mannucci, E., Monami, M. Bone Fractures with Sodium-Glucose Co-transporter-2 Inhibitors: How Real is the Risk?. Drug Saf 40, 115–119 (2017). https://doi.org/10.1007/s40264-016-0470-5
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DOI: https://doi.org/10.1007/s40264-016-0470-5