Key result
SGLT2 inhibitors linked to ~18% lower risk of incident osteoporosis in type 2 diabetes.
Why the study?
Although SGLT2 inhibitors have demonstrated cardiovascular protection and reduced heart failure hospitalization, the association between SGLT2i use and incident osteoporosis in patients with type 2 diabetes remained unclear.
Does SGLT2 inhibitor use reduce the risk of incident osteoporosis in patients with type 2 diabetes?
Cohort (n=929,241)
Does SGLT2 inhibitor use reduce the risk of incident osteoporosis in patients with type 2 diabetes?
Answers are grounded in this paper and cite their sources.
In a large real-world Taiwanese cohort of patients with type 2 diabetes, prescription of SGLT2 inhibitors was associated with an 17-18% lower risk of developing new-onset osteoporosis compared to non-SGLT2i use.
Background Clinical trials have shown the cardiovascular protective effect of sodium-glucose cotransporter-2 inhibitor (SGLT2i) and reduced hospitalization for heart failure. However, the association of the use of SGLT2i and incident osteoporosis in patients with type 2 diabetes (T2D) remains unclear. Purpose To evaluate the risk of incident osteoporosis with the use of SGLT2i in patients with T2D. Methods This is a population-based cohort study utilizing Taiwan’s National Health Insurance Research Database. We employed the Cox proportional hazards model and propensity score matching (PSM) analyses to evaluate the association between SGLT2i use and osteoporosis risk. The osteoporosis risk between groups was estimated using the Kaplan-Meier method (log-rank analyses). Results After the 1:2 matching by age, sex, and duration of type 2 diabetes, this cohort study included 309,747 participants in the SGLT2i group and 619,494 participants in the non-SGLT2i group from 2016 to 2022. In the adjusted Cox proportional hazards model, SGLT2i was associated with a 18% reduction in the risk of incident osteoporosis [HR=0.82, 95% confidence interval (CI): 0.79-0.82]. After propensity score 1:1 matching, a total of 274,329 patients in the SGLT2i group and 274,329 in the non-SGLT2i group were included in the analysis. The SGLT2i group was consistently associated with a lower risk of incident osteoporosis (adjusted hazard ratio: 0.83, 95% confidence interval: 0.80–0.86). The results of the Kaplan-Meier curve analysis indicated that individuals who utilized SGLT2i had a decreased rate of incident osteoporosis (Figures 1 & 2). Conclusions In real-world practice, patients with T2D prescribed SGLT2 inhibitors were at lower risk of incident osteoporosis than those not prescribed SGLT2 inhibitors.
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Jong et al. (2026) conducted a cohort in Type 2 diabetes (n=929,241). SGLT2 inhibitors vs. Non-SGLT2i use was evaluated on Incident osteoporosis (HR 0.82, 95% CI 0.79-0.82). SGLT2 inhibitor use in patients with type 2 diabetes was associated with an 18% lower risk of incident osteoporosis (HR 0.82; 95% CI 0.79-0.82; PSM-adjusted HR 0.83; 95% CI 0.80-0.86).
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