Use of SGLT2 inhibitors may not increase fracture risk in CKD patients

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Kaze does not report related financial disclosures. See this study for relevant financial disclosures of all other authors.

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Important points:

  • Canagliflozin showed beneficial results on serum phosphate, plasma FGF-23 and plasma PTH.
  • The association between SGLT2i and fracture risk is inconclusive.

Recently published studies show that SGLT2 inhibitors are often associated with abnormalities in bone and mineral metabolism, but it remains unclear whether these are associated with increased fracture risk in patients with chronic kidney disease. .

“[Chronic kidney disease] CKD is often associated with disorders of bone and mineral metabolism, including abnormalities of calcium, phosphorus, parathyroid hormone, or vitamin D metabolism. So are abnormalities in bone mineralization, turnover, volume, linear growth, and strength. ” Arnaud D. Kazet, MD, MPH, wrote a colleague. “This review analyzes recent evidence for safety. [SGLT2 inhibitors] SGLT2i is associated with bone and mineral metabolism, and the potential underlying mechanisms and clinical implications are discussed. “

Bone marrow transplant surgery.

Canagliflozin showed beneficial results on serum phosphate, plasma FGF-23 and plasma PTH. Image: Adobe Stock.

The researchers conducted a meta-analysis of recently published studies and found several studies showing that SGLT2i can increase serum phosphate levels and affect bone and mineral homeostasis. discovered.

For example, canagliflozin was associated with beneficial outcomes in a placebo-controlled randomized crossover study of 25 healthy adults. Treatment increased serum phosphate levels by 16%, plasma FGF-23 levels by 20%, and plasma PTH levels by 25%. According to the review, canagliflozin also reduced levels of 1,25-dihydroxyvitamin D by 10%.

“There was an increase in tubular reabsorption of phosphate within 2-4 hours after administration of canagliflozin,” the researchers wrote. “Peak levels of FGF-23 were recorded approximately 12 hours after peak serum phosphorus levels.”

Dapagliflozin and empagliflozin also showed similar effects on these markers. However, changes in bone turnover markers were inconsistent across different studies.

According to the review, SGLT2i is an emerging class of antidiabetic drugs that may have positive cardiovascular and renal effects in patients with CKD. Use “is steadily increasing among patients with CKD, but major professional bodies recommend the use of this class of agents for this patient population.”

However, the association between SGLT2i and fracture risk in CKD patients is still inconclusive. Some studies reported no significant difference in fracture risk between SGLT2i users and non-users, but other studies showed conflicting results, the researchers noted. ing.

As the use of SGLT2i continues to increase, it is important to monitor and evaluate its effects on bone health, wrote Kaze et al. Further studies are needed to assess the impact of SGLT2i on fracture risk in CKD patients, especially those with high baseline risk.

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