DPP-4 inhibitor therapy and bone fractures in people with Type 2 diabetes - A systematic review and meta-analysis

Mamza, J; Marlin, C; Wang, C; Chokkalingam, K; Idris, I; (2016) DPP-4 inhibitor therapy and bone fractures in people with Type 2 diabetes - A systematic review and meta-analysis. Diabetes research and clinical practice, 116. pp. 288-98. ISSN 0168-8227 DOI: https://doi.org/10.1016/j.diabres.2016.04.029

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AIM: Fracture risk is higher in older adults with Type 2 diabetes mellitus (T2DM). Oral glucose-lowering medications have different effects on bone metabolism. The purpose of this study is to appraise the evidence from literature and determine the effect of dipeptidyl peptidase-4 (DPP-4) inhibitor on the risk of developing bone fractures. METHODS: Using Boolean search terms, the search strategy combined synonyms of 'fracture' and 'DPP-4 inhibitor'. Comprehensive electronic databases which include EMBASE, MEDLINE, the EMA and the WHO ICTRP databases were searched for randomised controlled trial (RCT) studies which compared a DPP-4 inhibitor with an active comparator or placebo amongst patients with T2DM. Meta-analysis was performed to compare DPP-4 inhibitor with either an active comparator or a placebo. The outcome measure was the presence or absence of fracture. RESULTS: The search yielded 5061 records relating to fractures and DPP-4 inhibitor, from which 51 eligible RCTs were selected for meta-analysis (N=36,402). Thirty-seven (37) studies compared DPP-4 inhibitor with placebo (n=23,974), while fourteen (14) studies (n=12,428) compared DPP-4 inhibitor with an active comparator. The mean age of patients was 57.5+/-5.4years, the average glycated haemoglobin (HbA1c) was 8.2%, while the average BMI was 30+/-2kg/m(2). Overall, there was no significant association of fracture events with the use of DPP-4 inhibitor when compared with placebo (OR; 0.82, 95% CI 0.57-1.16, P=0.9) or when DPP-4 inhibitor was compared against an active comparator (OR; 1.59, 95% CI 0.91-2.80, P=0.9). CONCLUSION: This study offers a larger, up-to-date review of the subject. The meta-analysis showed that there was no significant association between DPP-4 inhibitor use and the incidence of fractures.

Item Type: Article
Keywords: Diabetes Mellitus, Type 2/*drug therapy, Dipeptidyl-Peptidase IV Inhibitors/*adverse effects/therapeutic use, Fractures, Bone/*chemically induced, Hemoglobin A, Glycosylated/metabolism, Humans, Hypoglycemic Agents/*adverse effects/therapeutic use, Randomized Controlled Trials as Topic, Dipeptidyl peptidase-4 inhibitor, Fracture, Meta-analysis, Diabetes Mellitus, Type 2, drug therapy, Dipeptidyl-Peptidase IV Inhibitors, adverse effects, therapeutic use, Fractures, Bone, chemically induced, Hemoglobin A, Glycosylated, metabolism, Humans, Hypoglycemic Agents, adverse effects, therapeutic use, Randomized Controlled Trials as Topic
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 27321347
URI: http://researchonline.lshtm.ac.uk/id/eprint/4645632


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