The Effects of Switching from Dipeptidyl Peptidase-4 Inhibitors to Glucagon-Like Peptide-1 Receptor Agonists on Bone Mineral Density in Diabetic Patients

Abstract

Chun-Feng Huang,1– 3 Tso-Yen Mao,3 Shinn-Jang Hwang1,2 1Division of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan, Republic of China; 2Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China; 3Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan, Republic of ChinaCorrespondence: Tso-Yen Mao, Department of Leisure Services Management, Chaoyang University of Technology, 168, Jifeng E. Road, Wufeng District, 413, Taichung, Taiwan, Republic of China, Tel [phone] #7453, Fax [phone], Email [email protected] Shinn-Jang Hwang, En Chu Kong Hospital, 399, Fuxing Road, Sanxia District, 237, New Taipei City, Taiwan, Republic of China, Tel [phone], Fax [phone], Email [email protected]: Diabetes increases the risk of fragility fractures. As a result, when choosing a diabetes treatment, whether the drug affects bone density should be taken into account. The goal of this study was to determine how switching from dipeptidyl peptidase-4 inhibitors (DPP-4i) to glucagon-like peptide-1 receptor agonists (GLP-1RA) influenced bone mineral density (BMD) in diabetic patients.Patients and Methods: In this retrospective cohort study, diabetic patients with osteoporosis or osteopenia who used DPP-4i but not anti-osteoporosis medications were divided into two groups: those who switched to GLP-1RA (n = 132) and those who did not (control group, n = 133). We compared changes in glycemic control and BMD with and without conversion from DPP-4i to GLP-1RA.Results: Prior to switching, there was no difference between the groups in terms of age, gender, glycosylated hemoglobin (HbA1c), or BMD. HbA1c was 8.7% in the participants (mean age 62.7 years, 17.4% female). Despite the fact that there was no difference in femoral neck BMD, the GLP-1RA group had a greater decrease in lumbar spine BMD (− 0.028 g/cm2 versus − 0.019 g/cm2, p = 0.041) than the control group. Furthermore, HbA1c levels in the GLP-1RA-treated group were considerably lower than in the control group (7.5% versus 8.0%, p = 0.027).Conclusion: While switching to GLP-1RA improves glycemic control, it appears to have a less favorable effect on bone density than continuing DPP-4i. More research is needed, however, to determine whether diabetic patients with low bone density should be switched from DPP-4i to GLP-1RA.Keywords: bone mineral density, diabetes, dipeptidyl peptidase-4 inhibitor, glucagon-like peptide-1 receptor agonist, osteoporosis

Keywords

• bone mineral density
• diabetes
• dipeptidyl peptidase-4 inhibitor
• glucagon-like peptide-1 receptor agonist
• osteoporosis