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Introduction <p>This study aimed to compare the risk of osteoporosis between sodium–glucose cotransporter 2 inhibitors (SGLT2is) and thiazolidinediones (TZDs) in older women with type 2 diabetes (T2D).</p> Materials and methods <p>We conducted a population-based cohort study using the Korean National Health Insurance data. This study included women aged ≥ 55&#xa0;years with T2D who used SGLT2is or TZDs between January 2022 and December 2023. Inverse probability of treatment weighting (IPTW) using propensity scores was employed to balance baseline covariates between SGLT2i and TZD users. Adjusted hazard ratios (aHRs) were estimated using multivariable weighted Cox proportional hazards models.</p> Results <p>Among 8,304 and 2,147 patients who initiated SGLT2i or TZD therapy, respectively, 5,358 SGLT2i and 1,169 TZD users were included in the Cox model. SGLT2i use was associated with a lower risk of osteoporosis than TZD use (aHR, 0.78; 95% confidence interval [CI] 0.69–0.89). The incidence rates of osteoporosis were 6.7 (95% CI 6.0–7.4) and 9.1 (95% CI 7.4–10.9) per 100 person-years for SGLT2i and TZD users, respectively. Compared with non-use, use of proton pump inhibitors (PPIs) for 270–364&#xa0;days and metformin in the year prior to follow-up were associated with higher osteoporosis risk (aHRs 1.25 [95% CI 1.01–1.55] and 1.31 [95% CI 1.10–1.55], respectively).</p> Conclusion <p>Despite concerns about a potential association between SGLT2is and reduced bone mineral density, our findings suggest a lower risk of osteoporosis with SGLT2is than with TZDs among older, likely postmenopausal women with T2D.</p>

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Osteoporosis risk with sodium–glucose cotransporter 2 inhibitors versus thiazolidinediones in older women with diabetes

  • 期刊论文

  • 发表日期：

    2026年2月18日

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  • Hyeon Jeong Lee,
  • Pusoon Chun

摘要

Introduction

This study aimed to compare the risk of osteoporosis between sodium–glucose cotransporter 2 inhibitors (SGLT2is) and thiazolidinediones (TZDs) in older women with type 2 diabetes (T2D).

Materials and methods

We conducted a population-based cohort study using the Korean National Health Insurance data. This study included women aged ≥ 55 years with T2D who used SGLT2is or TZDs between January 2022 and December 2023. Inverse probability of treatment weighting (IPTW) using propensity scores was employed to balance baseline covariates between SGLT2i and TZD users. Adjusted hazard ratios (aHRs) were estimated using multivariable weighted Cox proportional hazards models.

Results

Among 8,304 and 2,147 patients who initiated SGLT2i or TZD therapy, respectively, 5,358 SGLT2i and 1,169 TZD users were included in the Cox model. SGLT2i use was associated with a lower risk of osteoporosis than TZD use (aHR, 0.78; 95% confidence interval [CI] 0.69–0.89). The incidence rates of osteoporosis were 6.7 (95% CI 6.0–7.4) and 9.1 (95% CI 7.4–10.9) per 100 person-years for SGLT2i and TZD users, respectively. Compared with non-use, use of proton pump inhibitors (PPIs) for 270–364 days and metformin in the year prior to follow-up were associated with higher osteoporosis risk (aHRs 1.25 [95% CI 1.01–1.55] and 1.31 [95% CI 1.10–1.55], respectively).

Conclusion

Despite concerns about a potential association between SGLT2is and reduced bone mineral density, our findings suggest a lower risk of osteoporosis with SGLT2is than with TZDs among older, likely postmenopausal women with T2D.