Comparative risk of osteoporosis in older women with type 2 diabetes receiving sodium-glucose cotransporter 2 inhibitor or dipeptidyl peptidase-4 inhibitor: A nationwide cohort study.

Abstract

To compare osteoporosis risk associated with sodium-glucose cotransporter 2 inhibitor (SGLT2i) versus dipeptidyl peptidase-4 inhibitor (DPP-4i) in older women with type 2 diabetes (T2D). This cohort study used the Korean National Health Insurance database. Adjusted hazard ratios (aHRs) were estimated using multivariable Cox regression. Sensitivity analysis was performed using inverse probability of treatment weighting (IPTW). Among 1715,337 women aged ≥ 55 years with T2D, 5364 SGLT2i users and 26,504 DPP-4i users were analyzed. The incidence rates of osteoporosis were 6.7 (95 % CI, 6.0-7.4) and 7.0 (95 % CI, 6.7-7.3) per 100 person-years in the SGLT2i and DPP-4i groups, respectively. Osteoporosis risk with SGLT2i was comparable to DPP-4i (aHR, 0.93; 95 % CI, 0.89-1.04). These results remained consistent in the sensitivity analysis using IPTW (aHR, 0.95; 95 % CI, 0.89-1.00). Subgroup analyses showed a slightly lower osteoporosis risk with SGLT2i in patients aged 55-64 years (aHR, 0.84; 95 % CI, 0.76-0.93), those without prior rheumatoid arthritis (aHR, 0.90; 95 % CI, 0.83-0.97), proton pump inhibitor use (aHR, 0.88; 95 % CI, 0.80-0.96), or oral corticosteroid use (aHRs, 0.91; 95 % CI, 0.85-0.97). SGLT2i was comparable to DPP-4i in osteoporosis risk among older women with T2D.