Fracture Risk After Initiation of Use of Canagliflozin
Authors: Michael Fralick, Seoyoung C. Kim, Sebastian Schneeweiss, Dae Kim, Donald A. Redelmeier, Elisabetta Patorno
Journal: Annals of Internal Medicine (2019)

Letters2 July 2019Fracture Risk After Initiation of Use of CanagliflozinMichael Fralick, MD, SM, Seoyoung C. Kim, MD, ScD, MSCE, Sebastian Schneeweiss, MD, ScD, Dae Kim, MD, ScD, Donald A. Redelmeier, MD, MSc, and Elisabetta Patorno, MD, DrPHMichael Fralick, MD, SMBrigham and Women's Hospital, Boston, Massachusetts (M.F., S.C.K., S.S., D.K., E.P.), Seoyoung C. Kim, MD, ScD, MSCEBrigham and Women's Hospital, Boston, Massachusetts (M.F., S.C.K., S.S., D.K., E.P.), Sebastian Schneeweiss, MD, ScDBrigham and Women's Hospital, Boston, Massachusetts (M.F., S.C.K., S.S., D.K., E.P.), Dae Kim, MD, ScDBrigham and Women's Hospital, Boston, Massachusetts (M.F., S.C.K., S.S., D.K., E.P.), Donald A. Redelmeier, MD, MScSunnybrook Health Sciences, Toronto, Ontario, Canada (D.A.R.), and Elisabetta Patorno, MD, DrPHBrigham and Women's Hospital, Boston, Massachusetts (M.F., S.C.K., S.S., D.K., E.P.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0320 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate Dr. Padmanabhan's interest in our study, which identified comparable rates of fracture among adults newly prescribed canagliflozin or a GLP-1 agonist. We agree that the baseline fracture risk for adults in our study was low and does not exclude the possibility that canagliflozin may increase fractures in adults at higher baseline risk for these events. Dr. Padmanabhan is also correct that our study lacked markers of bone turnover (for example, levels of vitamin D and calcium). However, we do not believe that such markers would be differentially lower at baseline in adults receiving canagliflozin, because the ...References1. Chamberlain JJ, Herman WH, Leal S, et al. Pharmacologic therapy for type 2 diabetes: synopsis of the 2017 American Diabetes Association standards of medical care in diabetes. Ann Intern Med. 2017;166:572-8. [PMID: 28288484]. doi:10.7326/M16-2937 LinkGoogle Scholar2. Schneeweiss S. A basic study design for expedited safety signal evaluation based on electronic healthcare data. Pharmacoepidemiol Drug Saf. 2010;19:858-68. [PMID: 20681003] doi:10.1002/pds.1926 CrossrefMedlineGoogle Scholar3. Graham DJ, Reichman ME, Wernecke M, et al. Stroke, bleeding, and mortality risks in elderly medicare beneficiaries treated with dabigatran or rivaroxaban for nonvalvular atrial fibrillation. JAMA Intern Med. 2016;176:1662-71. [PMID: 27695821] doi:10.1001/jamainternmed.2016.5954 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Brigham and Women's Hospital, Boston, Massachusetts (M.F., S.C.K., S.S., D.K., E.P.)Sunnybrook Health Sciences, Toronto, Ontario, Canada (D.A.R.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0567. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFracture Risk After Initiation of Use of Canagliflozin Michael Fralick , Seoyoung C. Kim , Sebastian Schneeweiss , Dae Kim , Donald A. Redelmeier , and Elisabetta Patorno Fracture Risk After Initiation of Use of Canagliflozin Hema Padmanabhan Metrics Cited byEffectiveness and safety of empagliflozin in routine care patients: Results from the EMPagliflozin compaRative effectIveness and SafEty ( EMPRISE ) studyCardiovascular benefits from SGLT2 inhibition in type 2 diabetes mellitus patients is not impaired with phosphate flux related to pharmacotherapyGuía ESC 2019 sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes (EASD)Clinical Benefit of Cardiorenal Effects of Sodium-Glucose Cotransporter 2 InhibitorsProceedings of the 2019 Santa Fe Bone Symposium: New Concepts in the Care of Osteoporosis and Rare Bone DiseasesSodium Glucose Cotransporter-2 Inhibition and Cardiorenal Protection 2 July 2019Volume 171, Issue 1Page: 80KeywordsBone remodelingCalciumDisclosureElderlyVitamin D ePublished: 2 July 2019 Issue Published: 2 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...