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Canagliflozin not linked to bone fractures in people with type 2 diabetes, study suggests

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The type 2 diabetes drug canagliflozin is not linked to an increased risk of fractures in middle-aged people, new research suggests.

Canagliflozin, marketed as Invokana, helps to lower blood glucose levels by encouraging glucose excretion from the kidneys.

The SGLT2 inhibitors drug class, which includes the drugs dapagliflozin (Forxiga) and empagliflozin (Jardiance) has previously been associated with an increased risk of fractures and poor bone health, but this new study raises questions about this reported risk.

University of Toronto scientists found no increased risk after comparing canagliflozin with another class of type 2 diabetes medication called GLP-1 agonists, which have not been linked to an increased risk of fractures.

They compared 80,000 people with type 2 diabetes taking Invokana with 80,000 people with type 2 diabetes who were taking GLP-1 agonists. They chief investigated bone data for upper and lower arms, and hip and pelvis fractures.

The average age of the people they studied was 55, a lower risk population. The researchers noted that they had not looked at older people, who are at a higher risk of fractures, and suggested more research was needed.

Lead researcher Dr Michael Fralick, who also works at the Brigham and Women’s Hospital in Boston, said: “We were interested in doing this study because there was one randomized trial that said there was an increased risk of bone fractures and another that said there wasn’t. So, we conducted a real-world study with almost 200,000 people with type 2 diabetes.

“I hope these findings are reassuring to patients and physicians because these are blockbuster medications for type 2 diabetes. This class of medicines can improve blood sugar levels and help reduce heart disease risk.”

Theories about why SGLT2 inhibitors have previously been linked with an increased fracture risk include dehydration and a potential to lower bone mineral density.

The study was published in the journal Annals of Internal Medicine.



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