Effect of sodium-glucose co-transporter-2 inhibitors (SGLT2i) on bone mineral density in type-2 diabetes mellitus treatment

In our study, we aimed to investigate the effect of SGLT-2 inhibitors, which are frequently used in the treatment of diabetes mellitus and one of the most important risk factors for osteoporosis, on bone mineral density. The study was conducted with the patients of the Department of Internal Medicine and the Department of Endocrinology and Metabolism at Bursa Uludağ University Faculty of Medicine between 2021 and 2022. 35 patients, who were followed up with the diagnosis of type 2 diabetes mellitus and commenced empagliflozin, dapagliflozin or metformin + empagliflozin combination, and subsequently followed up for at least 6 months, were included in the study. Demographic and clinical characteristics, laboratory, and DEXA data of these patients were recorded by examining the data 1 week after the commencement of treatment and in the 6th month. The evaluation was made by comparing the baseline and 6th-month values. The median age in the study was 56,03 (39-75) years. Of the patients, 27 (77,1%) were female and 8 (22,9%) were male. When the baseline and 6th-month values were examined, there was a significant decrease in HbA1c and fasting plasma glucose in all patients after SGLT-2 inhibitors, in line with the literature. Although no significant change was observed in creatinine value, a slight increase was detected in the GFR value. While no significant change was observed in calcium, parathormone and phosphorus values, a significant increase was found in 25-OH vitamin D (p=0,006). There was no significant change in the femoral neck BMD value, T and Z scores, and femur total BMD value and Z score, and also lumbar 1-4 vertebra total BMD value, T and Z scores on DEXA. However, unlike the literature, a slight but significant decrease was observed at the femoral total T score on DEXA (p=0,03). There are conflicting results in studies examining the relationship between SGLT-2 inhibitors and bone mineral density in the literature. In our study, no significant change was found in bone mineral density values, except for slight changes in femur total T scores with SGLT-2 inhibitors. Considering the relationship between diabetes mellitus and osteoporosis, prospective studies with larger series are needed to more clearly demonstrate the effects of SGLT-2 inhibitors on bone mineral density.