ENDO: Fracture Risk Up With Insulin Compared With Metformin in T2DM

For patients with type 2 diabetes, fracture risk is increased with insulin use compared with metformin use, according to a study presented at the annual meeting of the Endocrine Society, held from June 11 to 14 in Atlanta.

Sung Hye Kong, M.D., from the Seoul National University College of Medicine in South Korea, and colleagues examined the risks for major osteoporotic fracture (MOF) and hip fracture among 6,694 patients aged 50 years and older with type 2 diabetes who used the same antidiabetic medications over a year.

The researchers found that the incidence rates of MOF and hip fracture were 8.36 and 1.53 per 1,000 person-years, respectively, during a median follow-up of 6.1 years. After multivariate adjustments, insulin users had an increased risk for MOF and hip fracture compared with metformin users (hazard ratios [95 percent confidence intervals], 1.96 [1.28 to 3.02] and 3.06 [1.21 to 7.77], respectively). After covariate adjustments, the risks became insignificant for patients using a combination of insulin and metformin for MOF and hip fracture (hazard ratios [95 percent confidence intervals], 1.32 [0.77 to 2.27] and 2.68 [0.56 to 12.80], respectively). In a subgroup analysis, the risk for MOF was increased significantly for insulin versus metformin users only in those with hemoglobin A1c <7 percent or body mass index <25 kg/m².

“From real-world data using the common data model, we found that insulin users were at elevated risk of major osteoporotic and hip fracture compared to metformin users, which was attenuated in users with a combination of insulin and metformin,” Kong said in a statement.