The risk of fragility fractures in new users of dipeptidyl peptidase-4 inhibitors compared to sulfonylureas and other anti-diabetic drugs: A cohort study
| dc.contributor.author | Gamble, John-Michael | |
| dc.contributor.author | Donnan, Jennifer R. | |
| dc.contributor.author | Chibrikov, Eugene | |
| dc.contributor.author | Twells, Laurie K. | |
| dc.contributor.author | Midodzi, William K. | |
| dc.contributor.author | Majumdar, Sumit R. | |
| dc.date.accessioned | 2018-08-01T19:35:10Z | |
| dc.date.available | 2018-08-01T19:35:10Z | |
| dc.date.issued | 2018-02-01 | |
| dc.description.abstract | Aims 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.sponsorship | Canadian Institute for Health Research (FRN173599-287647) | en |
| dc.identifier.uri | https://dx.doi.org/10.1016/j.diabres.2017.12.008 | |
| dc.identifier.uri | http://hdl.handle.net/10012/13513 | |
| dc.language.iso | en | en |
| dc.publisher | Elsevier | en |
| dc.relation.uri | https://doi.org/10.1016/j.diabres.2017.12.008 | |
| dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 International | * |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | * |
| dc.subject | Cohort study | en |
| dc.subject | Dipeptidyl-peptidase 4 inhibitors | en |
| dc.subject | Fracture | en |
| dc.subject | Type 2 diabetes | en |
| dc.title | The risk of fragility fractures in new users of dipeptidyl peptidase-4 inhibitors compared to sulfonylureas and other anti-diabetic drugs: A cohort study | en |
| dc.type | Article | en |
| dcterms.bibliographicCitation | Gamble, 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. https://doi.org/10.1016/j.diabres.2017.12.008 | en |
| uws.contributor.affiliation1 | Faculty of Science | en |
| uws.contributor.affiliation2 | Pharmacy | en |
| uws.peerReviewStatus | Reviewed | en |
| uws.scholarLevel | Faculty | en |
| uws.typeOfResource | Text | en |
| uws.typeOfResource | Text | en |