@article{10.7326/M18-0567,
    author = {Fralick, Michael and Kim, Seoyoung C. and Schneeweiss, Sebastian and Kim, Dae and Redelmeier, Donald A. and Patorno, Elisabetta},
    title = "{Fracture Risk After Initiation of Use of Canagliflozin: A Cohort StudyFracture Risk After Initiation of Use of Canagliflozin}",
    journal = {Annals of Internal Medicine},
    volume = {170},
    number = {3},
    pages = {155-163},
    year = {2019},
    month = {02},
    abstract = "{Sodium–glucose cotransporter-2 inhibitors promote glycosuria, resulting in possible effects on calcium, phosphate, and vitamin D homeostasis. Canagliflozin is associated with decreased bone mineral density and a potential increased risk for fracture.To estimate risk for nonvertebral fracture among new users of canagliflozin compared with a glucagon-like peptide-1 (GLP-1) agonist.Population-based new-user cohort study.Two U.S. commercial health care databases providing data on more than 70 million patients from March 2013 to October 2015.Persons with type 2 diabetes who initiated use of canagliflozin were propensity score–matched in a 1:1 ratio to those initiating use of a GLP-1 agonist.The primary outcome was a composite end point of humerus, forearm, pelvis, or hip fracture requiring intervention. Secondary outcomes included fractures at other sites. A fixed-effects meta-analysis that pooled results from the 2 databases provided an overall hazard ratio (HR).79 964 patients initiating use of canagliflozin were identified and matched to 79 964 patients initiating use of a GLP-1 agonist. Mean age was 55 years, 48\\% were female, average baseline hemoglobin A1c level was 8.7\\%, and 27\\% were prescribed insulin. The rate of the primary outcome was similar for canagliflozin (2.2 events per 1000 person-years) and GLP-1 agonists (2.3 events per 1000 person-years), with an overall HR of 0.98 (95\\% CI, 0.75 to 1.26). Risk for pelvic, hip, humerus, radius, ulna, carpal, metacarpal, metatarsal, or ankle fracture was also similar for canagliflozin (14.5 events per 1000 person-years) and GLP-1 agonists (16.1 events per 1000 person-years) (overall HR, 0.92 [CI, 0.83 to 1.02]).Unmeasured confounding, measurement error, and low fracture rate.In this study of middle-aged patients with type 2 diabetes and relatively low fracture risk, canagliflozin was not associated with increased risk for fracture compared with GLP-1 agonists.Brigham and Women's Hospital, Division of Pharmacoepidemiology and Pharmacoeconomics.}",
    issn = {0003-4819},
    doi = {10.7326/M18-0567},
    url = {https://dx.doi.org/10.7326/M18-0567},
    eprint = {https://annals.org/acp/content\_public/journal/aim/937814/aime201902050-m180567.pdf},
}