The Extraglycemic Effect of SGLT-2is on Mineral and Bone Metabolism and Bone Fracture

Front Endocrinol (Lausanne). 2022 Jul 7:13:918350. doi: 10.3389/fendo.2022.918350. eCollection 2022.

Abstract

Type 2 diabetes mellitus (T2DM) is a risk factor for osteoporosis. The effects of T2DM and anti-diabetic agents on bone and mineral metabolism have been observed. Sodium-glucose co-transporter 2 inhibitors (SGLT-2is) promote urinary glucose excretion, reduce blood glucose level, and improve the cardiovascular and diabetic nephropathy outcomes. In this review, we focused on the extraglycemic effect and physiological regulation of SGLT-2is on bone and mineral metabolism. SGLT-2is affect the bone turnover, microarchitecture, and bone strength indirectly. Clinical evidence of a meta-analysis showed that SGLT-2is might not increase the risk of bone fracture. The effect of SGLT-2is on bone fracture is controversial, and further investigation from a real-world study is needed. Based on its significant benefit on cardiovascular and chronic kidney disease (CKD) outcomes, SGLT-2is are an outstanding choice. Bone mineral density (BMD) and fracture risk evaluation should be considered for patients with a high risk of bone fracture.

Keywords: bone and mineral metabolism; bone fracture risk; bone turnover; sodium–glucose cotransporter-2 inhibitor; type 2 diabetes mellitus.

Publication types

  • Meta-Analysis
  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / drug therapy
  • Fractures, Bone* / etiology
  • Fractures, Bone* / prevention & control
  • Glucose
  • Humans
  • Minerals
  • Sodium-Glucose Transporter 2 Inhibitors* / pharmacology
  • Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use

Substances

  • Minerals
  • Sodium-Glucose Transporter 2 Inhibitors
  • Glucose