Risks vs Benefits for SGLT2 Inhibitor Medications

Bone Fractures

A clinical trial revealed that SGLT2 inhibitors, such as canagliflozin, decrease bone mineral density possibly leading to bone fractures.²⁹ Bone fractures occurred in about 1.5% of cases of patients taking 100 mg and 300 mg of canagliflozin compared with a 1.1% fracture rate among the placebo group.²⁹

Conclusion

Since the FDA approval of SGLT2 inhibitor medications, their usage has increased. The American Diabetes Association first recommends nonpharmacologic approaches, such as diet modification, exercise, and weight loss for patients diagnosed with DM, followed by a medicinal intervention with metformin if required. Sodium-glucose cotransporter 2 inhibitors are suggested as an additional medication in dual or triple pharmacotherapies when metformin alone fails to achieve normoglycemia.

Prior to starting a patient on SGLT2 inhibitor medication, clinicians should monitor hydration adequacy, check bone density, review the patient’s cardiac profile, and assess hepatic and renal function. Prescribing SGLT2 inhibitors should be restricted if the patient has a history of type 1 DM, ketosisprone T2DM, and in those with a glomerular filtration rate of < 60 mL/min. Considering the preexisting medical conditions of the patient and monitoring the blood glucose levels, renal function, and volume status at every visit should minimize risks and enhance the benefits of prescribing this new medication class.