Use of dipeptidyl peptidase-4 inhibitors and risk of bone fracture in patients with type 2 diabetes in Germany-A retrospective analysis of real-world data

In type 2 diabetes patients treated in German primary care practices, the use of dipeptidyl peptidase-4 inhibitor (DPP4i) in combination with metformin was associated with a significant decrease in the risk of developing bone fractures compared to metformin monotherapy. Introduction The goal of this study was to analyze the impact of dipeptidyl peptidase-4 inhibitor (DPP4i) use on the risk of bone fracture in patients diagnosed with type 2 diabetes mellitus (T2DM) in Germany. Methods Patients with an initial prescription of metformin between 2008 and 2014 from 1262 German general practitioner practices were selected. We matched 4160 DPP4i ever users to never users (1: 1) based on age, sex, diabetes duration, body mass index, index year, and physician type. The primary outcome measure was the rate of bone fractures within five years of the start of metformin or DPP-4i therapy. Timedependent Cox regression models were used to estimate hazard ratios (HRs) for fractures as a function of the DPP4i therapy. Results The mean age among the patients was 61.6 years (SD = 11.1 years), 59.6% were men, and 3.1% were followed in diabetologist practices. The mean diabetes duration was 1.5 years (SD = 2.4 years), HbA1c levels were 7.1% in DPP4i users and 6.6% in non-users, and body mass index was 31.5 kg/m(2) (SD = 5.0 kg/m(2)). Within five years of the index date, 6.4% of users and 8.3% of non-users developed bone fractures (log-rank p-value < 0.001). Within five years of the index date, 7.4% of female and 4.7% of male users and 13.3% of female and 8.8% of male non-users were diagnosed with bone fractures (both log-rank p-values < 0.001). The use of DPP4i was associated with a significant decrease in the risk of developing bone fractures (all patients HR = 0.67, 95% CI 0.54-0.84; women HR = 0.72, 95% CI 0.54-0.97; men HR = 0.62, 95% CI 0.44-0.88). Conclusion DPP4i use was associated with a decrease in the risk of bone fracture.