Effect of GLP-1 receptor agonists on bone mineral density, bone metabolism markers, and fracture risk in type 2 diabetes: a systematic review and meta-analysis.

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Acta Diabetologica Pub Date : 2025-02-22 DOI:10.1007/s00592-025-02468-5

Yimei Tan, Shuanghua Liu, Qizhi Tang

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引用次数: 0

Abstract

Aim: To systematically assess randomized controlled trials that evaluated the effect of glucagon-like peptide-1 (GLP-1) receptor agonists on fracture incidence, bone mineral density, and bone metabolism markers in individuals with type 2 diabetes.

Methods: From database setup to March 21, 2024, a search was conducted across nine Chinese and English databases. The Cochrane Risk of Bias Tool was applied to assess potential bias. Data analysis was performed using RevMan 5.3 and Stata 14.0. Subgroup analysis and meta regression were employed to explore sources of heterogeneity, and publication bias was evaluated using funnel plots and Egger's test.

Results: Twenty-five studies were included. The results of the meta-analysis indicated that GLP-1 receptor agonist was not significantly associated with an increased risk of fracture (RR = 0.80; 95% CI 0.47 to 1.36; P = 0.41). Additionally, improvement in lumbar spine BMD (MD = 0.07 g/cm², 95% CI 0.06 to 0.09, P < 0.00001), hip neck BMD (MD = 0.05 g/cm², 95% CI 0.03 to 0.08, P = 0.0001) and total hip BMD (MD = 0.06 g/cm², 95% CI 0.04 to 0.07, P < 0.00001) was superior to the control group. Similarly, GLP-1 receptor agonists significantly improved P1NP (SMD = 0.33, 95% CI 0.07 to 0.59, P = 0.01), OC (MD = 1.46 ug/L, 95% CI 1.10 to 1.83, P < 0.00001), 25-OH-D (SMD = 0.45, 95% CI 0.06 to 0.83, P = 0.02), and b-ALP (MD = 0.91ug/L, 95% CI 0.19 to 1.63, P = 0.01) while reducing β-CTX (SMD = - 0.34, 95% CI - 0.54 to - 0.14, P = 0.001). There was no significant impact on other bone metabolism markers, including N-MID-OT (SMD = 0.43, 95% CI 0.01 to 0.86, P = 0.05), ALP (SMD = - 0.00, 95% CI: - 0.25 to 0.25, P = 0.98), Calcium (MD = 0.00 mmol/L, 95% CI - 0.04 to 0.04, P = 0.94) and Phosphate (MD = 0.02 mmol/L, 95% CI - 0.04 to 0.07, P = 0.57).

Conclusion: This meta-analysis demonstrated no significant effect of GLP-1 receptor agonists on elevated fracture risk. There was a statistically significant improvement in BMD and certain bone turnover markers (β-CTX, P1NP, OC, b-ALP, and 25-OH-D). However, due to some limitations, further high-quality clinical studies with sufficient follow-up time are needed to draw more definitive conclusions.

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GLP-1受体激动剂对2型糖尿病患者骨密度、骨代谢指标和骨折风险的影响：一项系统综述和荟萃分析

目的：系统评估评估胰高血糖素样肽-1 （GLP-1）受体激动剂对2型糖尿病患者骨折发生率、骨密度和骨代谢指标影响的随机对照试验。方法：从数据库建立到2024年3月21日，对9个中英文数据库进行检索。应用Cochrane偏倚风险工具评估潜在偏倚。采用RevMan 5.3和Stata 14.0进行数据分析。采用亚组分析和meta回归探讨异质性来源，采用漏斗图和Egger检验评价发表偏倚。结果：纳入25项研究。荟萃分析结果显示，GLP-1受体激动剂与骨折风险增加无显著相关(RR = 0.80；95% CI 0.47 ~ 1.36；p = 0.41)。此外，腰椎骨密度（MD = 0.07 g/cm2, 95% CI 0.06 ~ 0.09, P 2, 95% CI 0.03 ~ 0.08, P = 0.0001）和全髋关节骨密度（MD = 0.06 g/cm2, 95% CI 0.04 ~ 0.07， P）均有改善。结论：本荟萃分析显示GLP-1受体激动剂对骨折风险升高无显著影响。骨密度和某些骨转换标志物（β-CTX、P1NP、OC、b-ALP和25-OH-D）的改善有统计学意义。然而，由于一些局限性，需要进一步的高质量临床研究和足够的随访时间来得出更明确的结论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Diabetologica 医学-内分泌学与代谢

CiteScore

7.30

自引率

2.60%

发文量

180

审稿时长

2 months

期刊介绍： Acta Diabetologica is a journal that publishes reports of experimental and clinical research on diabetes mellitus and related metabolic diseases. Original contributions on biochemical, physiological, pathophysiological and clinical aspects of research on diabetes and metabolic diseases are welcome. Reports are published in the form of original articles, short communications and letters to the editor. Invited reviews and editorials are also published. A Methodology forum, which publishes contributions on methodological aspects of diabetes in vivo and in vitro, is also available. The Editor-in-chief will be pleased to consider articles describing new techniques (e.g., new transplantation methods, metabolic models), of innovative importance in the field of diabetes/metabolism. Finally, workshop reports are also welcome in Acta Diabetologica.