Propensity score-matched analysis reveals suppression of the Sema3A/NRP1/Plexin-A1 bone signaling pathway in postmenopausal diabetic women, indicating early subclinical effects on bone health.
Propensity score-matched comparison of 23 SGLT2 inhibitor users and 23 non-users revealed that SGLT2 inhibitor use was associated with significantly lower Neuropilin-1 (NRP1) levels (74.25 vs. 87.61 ng/mL; p = 0.015) and a higher Sema3A/NRP1 ratio (0.14 vs. 0.12; p = 0.006), indicating functional impairment of the Sema3A/NRP1/Plexin-A1 bone signaling axis with compensatory Sema3A upregulation. Classical bone turnover markers (P1NP, CTX, coupling index) and DXA-derived BMD did not significantly differ between groups. These findings suggest that SGLT2 inhibitors may perturb the Sema3A/NRP1/Plexin-A1 axis before detectable changes in conventional markers, offering a novel mechanistic perspective to explain the inconsistency between existing meta-analyses on SGLT2 inhibitor bone safety.
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Erarslan et al. (2026) studied this question.
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