Does canagliflozin increase the risk of fractures in those with diabetes? 

Drugs
diabetes and fractures

A new study published in Annals of Internal Medicine analyzed data from over 79000 patients and compared the risk of fractures in type 2 diabetes patients using canagliflozin or GLP-1 agonists.

Type 2 diabetes is a condition that hinders the ability of the individual to metabolize glucose, leading to an alarming rise in blood-glucose levels. The disease is caused due to a failure in insulin’s function – the key hormone for regulating glucose abundance in the body. This hormone is either not made in an adequate amount or the patient’s body fails to utilize the existing insulin (insulin resistance). Type 2 diabetes affects millions of people across the globe – with 90% of all diabetes patients in Canada suffering from this type of the disease.

Diabetes could affect the levels of other ions regulated by the kidney

To manage diabetes, clinicians often prescribe the drug canagliflozin which increases the ability of kidneys to excrete glucose from the body, restoring blood glucose to a normal level. However, since the kidneys are involved in regulating overall ion balance within the body, a sudden dramatic change in body’s glucose levels can lead to disturbances in levels of other ions that are regulated by the kidney. For instance, imbalances in calcium, phosphate and vitamin D within blood can increase the uptake of these ions from bone and in process compromise bone strength. This can lead to an increased risk of fractures in type 2 diabetes patients who are using canagliflozin.

GLP-1 agonists are thought to lower the risk of fractures

Another class of drugs that are prescribed by clinicians to manage diabetes includes the glucagon-line peptide-1 (GLP-1) agonists. These are thought to have a comparatively lower risk of causing fractures. However, there is very little information comparing these types of drugs. For this reason, there is a great interest to accurately compare the risk of fracture in patients using canagliflozin and (GLP-1) agonists.

Clinician investigators from the Brigham and Women’s Hospital in the United States compared the risk of fractures in 79974 patients using canagliflozin with an equal number of patients who were using GLP-1 agonists. They published their results in the Annals of Internal Medicine.

For the study, The patient data were analyzed over a period from March 2013 to October 2015 distilling information from U.S. based commercial medical databases housing data for over 70 million patients. The mean age of patients in this study was 55 years. The study calculated the fracture risk in the pelvic bone, hip bone, humerus, radius, ulna, carpal, metacarpal, metatarsal, and ankle fracture.

Similar incidences of fractures among patients using either drug

The study revealed that the incidence of fracture in both patient populations was remarkably similar. The study concluded that for middle-aged patients, the risk of fracture for patients on canagliflozin was not very different from the patients that we using GLP-1 agonists. The investigators suggested that in light of these findings, it is advisable to reevaluate the counseling given to patients regarding the side-effects of these drugs.

Written by Vinayak Khattar, Ph.D., M.B.A

Reference: Fralick, M., Kim, S. C., Schneeweiss, S., Kim, D., Redelmeier, D. A., & Patorno, E. (2019). Fracture risk after initiation of use of canagliflozin: A cohort study. Annals of Internal Medicine. doi:10.7326/M18-0567

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