Project 440882

Type 2 diabetes (T2DM) is a chronic condition of high blood sugar that affects 10% of Canadians and can cause numerous complications when not managed, including major cardiovascular events like stroke. Fractures are also a complication of T2DM- even with the same bone mineral density (BMD), people with T2DM have twice the risk of fracture than the general population. Fractures cause pain, disability, and lower quality-of-life for patients, and hip fractures alone cost the Canadian healthcare system $1.1 billion each year. Evidence suggests that a newer class of medications for T2DM called sodium-glucose transporter-2 inhibitors (SGLT2s) can affect bone health through changes in calcium and vitamin D levels, lowering BMD. One clinical trial showed an increased fracture risk with SGLT2s, but real-world studies in large, generalized populations found no risk. However, prior studies did not examine fractures in high-risk populations, like patients who are older, frail, or taking other medications that might affect BMD. Also, no direct comparison of the fracture risk between SGLT2s has been conducted, though different SGLT2 drugs have varying effects on BMD. Large, real-world studies are needed to identify if people with higher baseline fracture risk might be more susceptible to fractures caused by SGLT2 therapy, and if certain SGLT2s might pose greater risk than others. The proposed research will use electronic health insurance databases with information on over 100 million patients to identify high-fracture risk older adults (over 65 years of age and with at least 1 major fracture risk factor, like frailty) to compare fracture risk between SGLT2s and other T2DM medications, then compare fracture risk between SGLT2s. Research findings will inform T2DM management by informing whether stakeholders like clinicians and policymakers should prefer other T2DM medications over SGLT2s in high risk patients to reduce fractures in this population.