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dc.contributor.authorGamble, John-Michael
dc.contributor.authorDonnan, Jennifer R.
dc.contributor.authorChibrikov, Eugene
dc.contributor.authorTwells, Laurie K.
dc.contributor.authorMidodzi, William K.
dc.contributor.authorMajumdar, Sumit R. 19:35:10 (GMT) 19:35:10 (GMT)
dc.description.abstractAims Mixed evidence exists for the effect of incretin-based therapies on osteoporosis in type-2 diabetes. Therefore, we conducted a cohort study to determine the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and common osteoporotic “fragility fractures” (upper extremity, hip, spine). Methods The UK-based Clinical Practice Research Datalink was used to identify adults without prior fractures receiving a new anti-diabetic drug or a new type-2 diabetes diagnosis between 2007 and 2016. The primary aim was to compare new-users of DPP-4 inhibitors versus new-users of sulfonylureas (SU). The association between DPP-4 inhibitors and incident fractures was estimated using Cox proportional hazards models. Deciles of high-dimensional propensity scores and other anti-diabetic drugs were used as covariates. Results We identified 7993 and 26,636 new-users of DPP-4 inhibitors and SUs, respectively. At cohort entry, the mean age was 58.8, 40% were female, mean diabetes duration was 1.3?years, and 42% had A1c?>?9%. Over 9?years (mean follow-up?=?1.2?years), the incident rate of fragility fractures was lower among DPP-4 versus SU users (3.0/1000 vs. 5.2/1000 person-years; P-value?=?0.007). After adjustment, there was no statistically significant difference in fracture risk (hazard ratio adjusted, aHR?=?0.80, 95%CI 0.51–1.24; P-value?=?0.3125). In a secondary analysis, DPP-4 inhibitors were not associated with a difference in fracture risk compared to insulin (aHR?=?0.91, 95%CI 0.40–2.09); however were associated with a lower fracture risk versus thiazolidinediones (aHR?=?0.47, 95%CI 0.26–0.83). Sensitivity analyses supported findings. Conclusions DPP-4 inhibitors are not associated with an increased risk of fragility fractures compared with SUs or insulin; however, are associated with a lower risk versus thiazolidinediones.en
dc.description.sponsorshipCanadian Institute for Health Research (FRN173599-287647)en
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.subjectCohort studyen
dc.subjectDipeptidyl-peptidase 4 inhibitorsen
dc.subjectType 2 diabetesen
dc.titleThe risk of fragility fractures in new users of dipeptidyl peptidase-4 inhibitors compared to sulfonylureas and other anti-diabetic drugs: A cohort studyen
dcterms.bibliographicCitationGamble, J.-M., Donnan, J. R., Chibrikov, E., Twells, L. K., Midodzi, W. K., & Majumdar, S. R. (2018). The risk of fragility fractures in new users of dipeptidyl peptidase-4 inhibitors compared to sulfonylureas and other anti-diabetic drugs: A cohort study. Diabetes Research and Clinical Practice, 136, 159–167.
uws.contributor.affiliation1Faculty of Scienceen

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