Efficacy of dipeptidyl peptidase IV inhibitors, thiazolidine
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The population-based cohort study evaluates the effect of anti-diabetic drugs on osteoporosis. The use of DPP-IV inhibitors does not increase the risk of osteoporosis compared with the use of sulfonylureas in patients with type 2 diabetes mellitus, while a weak association was found between thiazolidinediones and increased risk of osteoporosis.

The current study aimed to evaluate the effect of dipeptidyl peptidase IV inhibitors (DPP-IVi), thiazolidinedione (TZD), and sulfonylurea (SU) on osteoporosis in patients with type 2 diabetes.

A population-based cohort study was conducted for patients of 50–99 years of age who were prescribed DPP-IVi, TZD, or SU. A total of 381,404 patients were analyzed after inverse probability of treatment weighting. The association between the study drugs and osteoporosis was estimated using Cox proportional hazards models. Data of 220,166 patients who were prescribed DPP-IVi, 18,630 who were prescribed TZD, and 142,608 patients who were prescribed SU were set.

Results:
--In the multivariate-adjusted analysis, the hazard ratio (HR) of osteoporosis in the DPP-IVi group was not significantly different from that of the SU group (HR: 0.97), whereas the HR of osteoporosis in the TZD group was higher (HR: 1.13).

--In the subgroup analysis, the HRs of osteoporosis were higher with pioglitazone (HR: 1.14) in the TZD group and with glibenclamides (HR: 1.39) in the SU group, whereas drugs with lower HR in the DPP-IVi group were saxagliptin (HR: 0.93) and sitagliptin (HR: 0.93).

Conclusively, DPP-IV inhibitors do not increase the risk of osteoporosis compared with sulfonylureas in patients with type 2 diabetes mellitus, while a weak association was found between thiazolidinediones and increased risk of osteoporosis.

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