Relación entre medicamentos antidiabéticos y susceptibilidad a fracturas en pacientes diabéticos.

Abstract

Diabetes mellitus describes a multifactorial metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion and/or action. (Lozano, Fernández de Castro, Esbrit, & Álvarez-Arroyo, 2007). Patients with type 2 diabetes have higher bone mineral density; however, they also have a very high risk of osteoporotic fractures due to a combination of risk factors such as postmenopausal status, smoking, advanced age, and low physical activity (Gamble, y otros, 2018). Given the impact of diabetes on bone health, it is important to investigate whether the hypoglycemic medications prescribed to these patients may pose an even greater risk of fractures than the risk already associated with diabetes mellitus itself. Objective: To determine the relationship between different hypoglycemic medications and their susceptibility to increasing fracture risk. Methodology: A literature search was conducted using prestigious online databases such as Science Direct, Google Scholar, PubMed, and the National Library of Medicine of the National Center for Biotechnology Information. The search was performed using keywords in both Spanish and English, such as “antidiabetics and fracture risk,” “sulfonylureas fracture risk,” and “effects of antidiabetics on bone metabolism.” All these articles were assessed for risk of bias using tools such as CASPe and RoB 2. Results: Ten clinical trials were analyzed, which demonstrated that both insulin and thiazolidinediones have a negative effect on diabetic patients, making them more susceptible to fractures. Conclusions: Among all the antidiabetic medications analyzed in the different articles, we can conclude that the use of thiazolidinediones and insulin increases the susceptibility to fractures in diabetic patients who are prescribed these medications. While the use of sulfonylureas, SGLT2 inhibitors, DPP4, GLP-1 agonists, Biguanides, are hypoglycemic drugs that have a lower risk of fractures.