Study compares fracture risk using insulin compared to metformin

Patients with type 2 diabetes have an increased risk for fractures if they are using insulin or sulfonylurea compared to metformin-only users, despite their normal-to-high bone mineral density, according to research presented at ENDO 2022, the Endocrine Society's annual meeting in Atlanta, Ga.

"Patients using insulin or sulfonylurea are at a high risk of fractures compared to metformin-only users, and the risk could be higher in non-obese and well-controlled diabetic patients," said Dr Sung Hye Kong, Seoul National University Bundang Hospital in Seongnam, South Korea. "From real-world data using the common data model, we found that insulin users were at elevated risk of major osteoporotic and hip fracture compared to metformin users, which was attenuated in users with a combination of insulin and metformin.”


Kong and colleagues acknowledge that anti-diabetic medications have long been suspected of an increased risk for fractures among this patient population. However, after investigating longitudinal comparative studies, they learned that evidence of these effects is limited.

For their study, the researchers included 6,694 patients aged ≥50 years from the common data model (CDM) database between 2008 and 2011, who used the same anti-diabetic medications for over a year. They analysed risks of major osteoporotic fractures and hip fractures in each group using the Cox proportional hazards model compared with a metformin group as a reference.


This increased fracture risk among people who used insulin was exaggerated among people who do not have obesity and those with well-controlled diabetes. These findings suggest a need for routine fracture risk assessments in patients with diabetes.