Sodium-Glucose Cotransporter 2 Inhibitors in Diabetes and Bone Health
Summary
SGLT2 inhibitors reduce renal glucose reabsorption, improving glycaemic control and demonstrating cardiovascular and renal protection in type 2 diabetes. However, alterations in mineral homeostasis, bone turnover and skeletal microarchitecture have prompted investigation into their effects on bone health. Clinical and preclinical studies have explored effects on calcium and phosphate handling, bone mineral density and fracture incidence. While some trials have reported transient increases in parathyroid hormone and phosphate, meta-analyses and real-world cohorts largely observe no substantive rise in fracture risk across varied patient groups. The interplay between weight loss, altered electrolytes and changes in bone remodelling underlies mechanistic hypotheses. Given the global rise in diabetes and the expanding indications for these agents, understanding their impact on skeletal integrity is essential for optimising long-term outcomes and guiding bone-protective strategies in at-risk populations.
Research from Nature Portfolio
No recent Nature Portfolio content available.
Sodium-Glucose Cotransporter 2 Inhibitors in Diabetes and Bone Health publication trend
The graph below shows the total number of articles in sodium-glucose cotransporter 2 inhibitors in diabetes and bone health across all publications each year (not limited to Nature Index journals).
Technical terms
Sodium-glucose cotransporter 2 (SGLT2) inhibitors: A class of drugs that block glucose reabsorption in the proximal renal tubule, lowering blood glucose and exerting diuretic and cardioprotective effects.
Bone mineral density (BMD): A measurement reflecting the amount of mineral in bone, used as an indicator of bone strength and osteoporosis risk.
Bone turnover markers: Biochemical substances (e.g. osteocalcin, C-terminal telopeptide) that reflect rates of bone formation and resorption.
Parathyroid hormone (PTH): A hormone regulating calcium and phosphate homeostasis that may increase in response to altered renal mineral handling.
Fibroblast growth factor 23 (FGF23): A hormone secreted by osteocytes that regulates phosphate excretion and vitamin D metabolism.
Skeletal microarchitecture: The structural integrity of bone at trabecular and cortical levels, critical for mechanical strength beyond BMD.
References
- Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Bone Metabolism and Fracture Risk. Frontiers in Pharmacology (2019).
- Association of Sodium-Glucose Cotransporter–2 Inhibitors With Fracture Risk in Older Adults With Type 2 Diabetes. JAMA Network Open (2021).
- SGLT2 inhibition versus sulfonylurea treatment effects on electrolyte and acid-base balance: secondary analysis of a clinical trial reaching glycemic equipoise: Tubular effects of SGLT2 inhibition in Type 2 diabetes.. Clinical Science (2020).
- Effect of Dapagliflozin on Urine Metabolome in Patients with Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism (2021).
- The Extraglycemic Effect of SGLT-2is on Mineral and Bone Metabolism and Bone Fracture. Frontiers in Endocrinology (2022).
- Mineral and Electrolyte Disorders With SGLT2i Therapy. JBMR Plus (2019).
Turn complex research questions into confident strategic decisions
When you're under pressure to set direction, justify investment, or understand your competitive position, you need more than raw data — you need trusted insights you can act on.
Benchmark your performance against global peers using robust, methodologically sound analysis.
Combine quantitative metrics with qualitative expert insight to uncover strengths, gaps and emerging opportunities.
Gain tailored, decision-ready recommendations aligned to your strategic priorities.
Talk to us to learn more about our data dashboards and bespoke strategy reports.
Grow research skills, confidence and careers with training built for every stage of the research lifecycle.
Developed with Nature Portfolio journal Editors and internationally renowned experts. Discover three ways to learn:
Self-paced, online courses in convenient bite-sized units, covering key skills across scientific writing, publishing, grant writing, data analysis, and more.
Expert trainer-led workshops with hands-on exercises and real-time feedback across core research skills, delivered via interactive group sessions.
Editor-led workshops combining core principles in writing and publishing, personalised 1:1 feedback from Nature Portfolio Editors and hands-on exercises.
Explore course catalogues and workshop agendas, enquire about the options or request institutional pricing.