An Association Between SGLT-2 Inhibitors and Bone Mineral Changes: A Critical Review

Abstract

The case of diabetes has now become a life-threatening modality in many countries. The treatment options for diabetes have seen a major shift towards sodium glucose co-transporter-2 (SGLT-2) inhibitors. Diabetes has been reported several times to cause changes pathologically in bone mineralization and metabolism while SGLT-2 inhibitors are also believed to have a negative impact on these bone homeostatic processes. In this study, we have particularly focused on the bone mineral changes occurring due to the application of anti-SGLT-2 agents, that will help to answer to the question ‘do SGLT-2 inhibitors actually have adverse impact on the bone mineralization and metabolic processes or this pathological deterioration of the bone is solely on account of diabetes?’. To test this hypothesis, we conducted a decisive and critical review of literature by screening several data bases with a number of keywords. We selected 37 appropriate studies to include in this work, where, a total of 20 studies were associated with observational trials, 10 were the case reports, one was a case series, and the rest of the articles concern meta-analysis or review papers. In this analysis, we have observed that the most of the discussed studies reveal SGLT-2 inhibitors to be safe in diabetic patients and there are no significant abnormalities to bone mineralization except the agent canagliflozin. However, the authors still suggest performing large prospective studies to validate a strong association between SGLT-2 inhibitors and the bone mineral changes as the clear temporal relationships are lacking due to a limited number of studies.