Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Bone Metabolism and Fracture Risk
The effect of anti-diabetic medications on bone metabolism has received increasing attention, considering that type 2 diabetes mellitus is a common metabolic disorder with adverse effects on bone metabolism. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel anti-diabetic medications that...
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Frontiers Media S.A.
2019-01-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphar.2018.01517/full |
| _version_ | 1818528251047313408 |
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| author | Yangli Ye Chenhe Zhao Jing Liang Yinqiu Yang Mingxiang Yu Xinhua Qu |
| author_facet | Yangli Ye Chenhe Zhao Jing Liang Yinqiu Yang Mingxiang Yu Xinhua Qu |
| author_sort | Yangli Ye |
| collection | DOAJ |
| description | The effect of anti-diabetic medications on bone metabolism has received increasing attention, considering that type 2 diabetes mellitus is a common metabolic disorder with adverse effects on bone metabolism. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel anti-diabetic medications that prevent glucose resorption at the proximal convoluted tubules in the kidney, increasing urinary glucose excretion, and decreasing the blood glucose level. The superiority of SGLT2 inhibitors shows in reducing the glucose level independent of insulin secretion, lowering the risk of hypoglycemia, and improving cardiovascular outcomes. SGLT2 inhibitors have been associated with genital mycotic infections, increased risk of acute kidney injury, dehydration, orthostatic hypotension, and ketoacidosis. Moreover, the effect of SGLT2 inhibitors on bone metabolism and fracture risk has been widely taken into consideration. Our review summarizes the results of current studies investigating the effects of SGLT2 inhibitors on bone metabolism (possibly including increased bone turnover, disrupted bone microarchitecture, and reduced bone mineral density). Several mechanisms are probably involved, such as bone mineral losses due to the disturbed calcium and phosphate homeostasis, as confirmed by an increase in fibroblast growth factor 23 and parathyroid hormone levels and a decrease in 1,25-dihydroxyvitamin D levels. SGLT2 inhibitors might indirectly increase bone turnover by weight loss. Lowering the blood glucose level might ameliorate bone metabolism impairment in diabetes. The effect of SGLT2 inhibitors on bone fractures remains unclear. Evidence indicating the direct effect of SGLT2 inhibitors on fracture risk is lacking and increased falls probably contribute to fractures. |
| first_indexed | 2024-12-11T06:47:20Z |
| format | Article |
| id | doaj.art-922911616b2e462cba4017f03df0df87 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-11T06:47:20Z |
| publishDate | 2019-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-922911616b2e462cba4017f03df0df872022-12-22T01:17:02ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122019-01-01910.3389/fphar.2018.01517425628Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Bone Metabolism and Fracture RiskYangli Ye0Chenhe Zhao1Jing Liang2Yinqiu Yang3Mingxiang Yu4Xinhua Qu5Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Bone and Joint Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaThe effect of anti-diabetic medications on bone metabolism has received increasing attention, considering that type 2 diabetes mellitus is a common metabolic disorder with adverse effects on bone metabolism. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel anti-diabetic medications that prevent glucose resorption at the proximal convoluted tubules in the kidney, increasing urinary glucose excretion, and decreasing the blood glucose level. The superiority of SGLT2 inhibitors shows in reducing the glucose level independent of insulin secretion, lowering the risk of hypoglycemia, and improving cardiovascular outcomes. SGLT2 inhibitors have been associated with genital mycotic infections, increased risk of acute kidney injury, dehydration, orthostatic hypotension, and ketoacidosis. Moreover, the effect of SGLT2 inhibitors on bone metabolism and fracture risk has been widely taken into consideration. Our review summarizes the results of current studies investigating the effects of SGLT2 inhibitors on bone metabolism (possibly including increased bone turnover, disrupted bone microarchitecture, and reduced bone mineral density). Several mechanisms are probably involved, such as bone mineral losses due to the disturbed calcium and phosphate homeostasis, as confirmed by an increase in fibroblast growth factor 23 and parathyroid hormone levels and a decrease in 1,25-dihydroxyvitamin D levels. SGLT2 inhibitors might indirectly increase bone turnover by weight loss. Lowering the blood glucose level might ameliorate bone metabolism impairment in diabetes. The effect of SGLT2 inhibitors on bone fractures remains unclear. Evidence indicating the direct effect of SGLT2 inhibitors on fracture risk is lacking and increased falls probably contribute to fractures.https://www.frontiersin.org/article/10.3389/fphar.2018.01517/fullsodium-glucose co-transporter 2bone turnoverbone microarchitecturebone strengthbone mineral densityfracture risk |
| spellingShingle | Yangli Ye Chenhe Zhao Jing Liang Yinqiu Yang Mingxiang Yu Xinhua Qu Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Bone Metabolism and Fracture Risk Frontiers in Pharmacology sodium-glucose co-transporter 2 bone turnover bone microarchitecture bone strength bone mineral density fracture risk |
| title | Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Bone Metabolism and Fracture Risk |
| title_full | Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Bone Metabolism and Fracture Risk |
| title_fullStr | Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Bone Metabolism and Fracture Risk |
| title_full_unstemmed | Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Bone Metabolism and Fracture Risk |
| title_short | Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Bone Metabolism and Fracture Risk |
| title_sort | effect of sodium glucose co transporter 2 inhibitors on bone metabolism and fracture risk |
| topic | sodium-glucose co-transporter 2 bone turnover bone microarchitecture bone strength bone mineral density fracture risk |
| url | https://www.frontiersin.org/article/10.3389/fphar.2018.01517/full |
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