Sodium–glucose cotransporter 2 inhibitor use and recurrent falls in Turkish older adults: a cross-sectional comparison with established fall-risk-increasing drugs

Falls are a major geriatric syndrome associated with substantial morbidity, functional decline, and loss of independence. Although sodium–glucose cotransporter 2 (SGLT2) inhibitors provide well-established cardiovascular and renal benefits, their association with falls in older adults remains uncertain because of limited and inconsistent evidence. Therefore, this study primarily aimed to investigate the association between SGLT2 inhibitor use and recurrent falls in older adults undergoing comprehensive geriatric assessment (CGA), and secondarily to compare these findings with those for other medication classes, including established fall-risk-increasing drugs. This retrospective cross-sectional study included 1,069 adults aged ≥ 65 years who underwent CGA. Recurrent falls were defined as ≥ 2 falls during the previous year. Participants were categorised as fallers or non-fallers. Demographic characteristics, comorbidities, medication use including SGLT2 inhibitors, laboratory findings, and CGA parameters were recorded. Logistic regression analyses were performed to identify medication groups associated with recurrent falls after sequential adjustment for confounding factors. A total of 1,069 older adults were included, of whom 298 (27.9%) had a history of recurrent falls. Fallers were older, had a higher comorbidity burden, poorer nutritional and functional status, greater frailty, and a higher frequency of polypharmacy than non-fallers ( p < 0.05). SGLT2 inhibitor use was not associated with recurrent falls (12.4% vs. 9.5%, p = 0.157) and Timed Up and Go test duration ( p = 0.975). In multivariable logistic regression analyses, SGLT2 inhibitor use was not associated with recurrent falls after full adjustment (OR 1.30, 95% CI 0.79–2.13; p = 0.299), whereas antidepressant use (OR 1.61, 95% CI 1.18–2.20; p = 0.002) and antimuscarinic drug use (OR 2.28, 95% CI 1.44–3.62; p < 0.001) remained independently associated with recurrent falls after full adjustment. SGLT2 inhibitor use was not independently associated with recurrent falls in older adults. When evaluating potentially inappropriate medications for fall risk and in the context of deprescribing, these findings suggest that established fall-risk-increasing drugs, particularly antidepressants and antimuscarinic agents, may warrant greater attention during medication review than SGLT2 inhibitors.