Editor’s Pick: New Drugs for Type 2 Diabetes: New Hopes and New Concerns About the Skeleton

Dr Berberoglu’s paper is a highly pertinent look at a new complication of diabetes: skeletal
fragility. The skeletal effects of a variety of newly approved drugs used in the treatment of
Type 2 diabetes mellitus are discussed, indicating the need for future research to specifically
identify patients who are most at risk of developing drug-induced bone fractures, making for
a fascinating read.

*Zehra Berberoglu

Department of Endocrinology and Metabolism, Ankara Education and Research Hospital, Ankara, Turkey
*Correspondence to zehraberberoglu@gmail.com

Disclosure: The author has declared no conflicts of interest.
Received: 01.03.16 Accepted: 05.10.16
Citation: EMJ Diabet. 2016;4[1]:66-73.


Diabetes is an important public health concern associated with significant morbidity, premature mortality, and health-system costs. Its global prevalence has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population in 2014. Additionally, the number of diabetic adults in the world increased from 108 million in 1980 to 422 million in 2014, with the majority of people affected by Type 2 diabetes mellitus (T2DM). More common in the elderly, T2DM frequently coexists with osteoporosis, causing >8.9 million fractures annually worldwide. On the other hand, skeletal fragility has emerged as a new complication of diabetes itself. Compared with osteoporosis, T2DM reduces bone quality rather than bone mineral density. Although DM-related complications are important in the aetiology, the effects of medications on bone metabolism and fracture risk should not be neglected. Common drugs used for T2DM might have a positive, neutral, or negative impact on skeletal health. This issue has clinical significance because many T2DM patients receiving therapy are in the age range at greatest risk of bone fractures. This review focusses specifically on and summarises the skeletal effects of recently marketed glucagon-like peptide-1 receptor agonists (GLP-1 RA), dipeptidyl peptidase-4 inhibitors (DPP-4i), and sodium-glucose cotransporter 2 inhibitors (SGLT2i).

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