PMID- 29206832
OWN - NLM
STAT- MEDLINE
DCOM- 20171229
LR  - 20181113
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 12
DP  - 2017
TI  - The effects of dipeptidyl peptidase-4 inhibitors on bone fracture among patients 
      with type 2 diabetes mellitus: A network meta-analysis of randomized controlled 
      trials.
PG  - e0187537
LID - 10.1371/journal.pone.0187537 [doi]
LID - e0187537
AB  - AIM: The association between dipeptidyl peptidase-4 inhibitors (DPP-4is), a class 
      of anti-diabetes, and bone fracture in patients with type 2 diabetes mellitus 
      (T2DM) is unknown. This meta-analysis aimed to systematically evaluate the 
      effects of DPP-4is on bone fracture in T2DM patients. METHODS: We searched the 
      Cochrane Library, Embase, Medline and ClinicalTrials.gov from inception through 
      April 28th, 2016 to identify randomized controlled trials (RCTs) that compared 
      DPP-4is with placebo or other anti-diabetes in T2DM patients. RCTs lasting more 
      than 12 weeks and having data on bone fracture were included. We conducted 
      random-effects meta-analysis to estimate odds ratios (ORs) and their 95% 
      confidence intervals (CIs), and network meta-analysis (NMA) to supplement direct 
      comparisons. Predictive interval plot and node-splitting method were used to 
      evaluate the heterogeneity and inconsistency for NMA, while the funnel plot was 
      applied to explore publication bias. Besides, study quality was assessed 
      according to Cochrane risk of bias tool. RESULTS: We identified 75 RCTs with a 
      total of 70,207 patients and 11 treatments: interventions included 5 DPP-4is 
      (alogliptin, linagliptin, saxagliptin, sitagliptin, vildagliptin), while controls 
      included placebo and 5 other anti-diabetes (sulfonylureas, glucagon-like 
      peptide-1 receptor agonists, metformin, thiazolidinediones, sodium-glucose 
      co-transporter 2 inhibitors). In the NMA, the risk of fracture for alogliptin 
      tended to decrease when versus placebo (OR, 0.51; 95% CI, 0.29 to 0.88). Besides, 
      aloglitpin had a lower risk compared with linagliptin (OR, 0.45; 95% CI, 0.20 to 
      0.99) and saxagliption (OR, 0.46; 95%CI, 0.25 to 0.84); the risk was higher with 
      saxagliptin when versus sitagliptin (OR, 1.90; 95% CI, 1.04 to 3.47) and 
      sulfonylureas (OR, 1.98; 95% CI, 1.06 to 3.71). In the direct pairwise 
      meta-analysis, alogliptin was associated with a non-significant tendency to 
      reduction of bone fracture compared with placebo (OR, 0.54; 95% CI, 0.29 to 
      1.01). Ranking probability analysis indicated alogliptin decreased the risk of 
      bone fracture most with a probability of 76.3%. CONCLUSION: Alogliptin may be 
      associated with a lower risk of bone fracture compared with placebo, linagliptin, 
      or saxagliptin, while other anti-diabetes did not seem to have an association 
      with the risk of bone fracture.
FAU - Yang, Jun
AU  - Yang J
AD  - Department of Epidemiology and Biostatistics, School of Public Health, Peking 
      University Health Science Centre, Beijing, China.
FAU - Huang, Chao
AU  - Huang C
AD  - Department of Epidemiology and Biostatistics, School of Public Health, Peking 
      University Health Science Centre, Beijing, China.
FAU - Wu, Shanshan
AU  - Wu S
AD  - National Clinical Research Center of Digestive Diseases, Beijing Friendship 
      Hospital, Capital Medical University, Beijing, China.
FAU - Xu, Yang
AU  - Xu Y
AD  - Department of Epidemiology and Biostatistics, School of Public Health, Peking 
      University Health Science Centre, Beijing, China.
FAU - Cai, Ting
AU  - Cai T
AD  - Department of Epidemiology and Biostatistics, School of Public Health, Peking 
      University Health Science Centre, Beijing, China.
FAU - Chai, Sanbao
AU  - Chai S
AD  - Department of Endocrinology and Metabolism, Peking University International 
      Hospital, Beijing, China.
FAU - Yang, Zhirong
AU  - Yang Z
AD  - The Primary Care Unit, School of Clinical Medicine, University of Cambridge, 
      Cambridge, United Kingdom.
FAU - Sun, Feng
AU  - Sun F
AUID- ORCID: 0000-0003-4334-6805
AD  - Department of Epidemiology and Biostatistics, School of Public Health, Peking 
      University Health Science Centre, Beijing, China.
FAU - Zhan, Siyan
AU  - Zhan S
AD  - Department of Epidemiology and Biostatistics, School of Public Health, Peking 
      University Health Science Centre, Beijing, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20171205
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Aged
MH  - Diabetes Mellitus, Type 2/complications/*drug therapy
MH  - Dipeptidyl-Peptidase IV Inhibitors/*therapeutic use
MH  - Female
MH  - Fractures, Bone/*prevention & control
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - *Randomized Controlled Trials as Topic
PMC - PMC5716604
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2017/12/06 06:00
MHDA- 2017/12/30 06:00
PMCR- 2017/12/05
CRDT- 2017/12/06 06:00
PHST- 2017/05/22 00:00 [received]
PHST- 2017/10/20 00:00 [accepted]
PHST- 2017/12/06 06:00 [entrez]
PHST- 2017/12/06 06:00 [pubmed]
PHST- 2017/12/30 06:00 [medline]
PHST- 2017/12/05 00:00 [pmc-release]
AID - PONE-D-17-19300 [pii]
AID - 10.1371/journal.pone.0187537 [doi]
PST - epublish
SO  - PLoS One. 2017 Dec 5;12(12):e0187537. doi: 10.1371/journal.pone.0187537. 
      eCollection 2017.