Adverse effects of SGLT2 inhibitors on bone health

Sodium–glucose cotransporter 2 (SGLT2) inhibitors provide metabolic and cardiorenal benefits for patients with type 2 diabetes but are associated with a number of safety issues. Here, we discuss evidence suggesting that indirect activation of the FGF23–1,25-dihydroxyvitamin D–parathyroid hormone axis by SGLT2 inhibition might contribute to adverse effects on bone health.

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Fig. 1: Time course of pharmacodynamic responses to canagliflozin treatment.


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J.E.B. is supported by funding from the Intramural Research Program of the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). S.I.T. acknowledges funding from the NIDDK (grant number P30DK072488).

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Correspondence to Simeon I. Taylor.

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J.E.B. declares no competing interests. S.I.T. is a consultant for Ionis Pharmaceuticals, has research support provided to the University of Maryland School of Medicine by Regeneron Pharmaceuticals and has ownership of stock in Celgene, Amgen and Abbott Laboratories.

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Blau, J.E., Taylor, S.I. Adverse effects of SGLT2 inhibitors on bone health. Nat Rev Nephrol 14, 473–474 (2018).

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