Table 1.

Summary of effect of glucose-lowering therapies on bone

Drug	Effect on bone	Comments
(1) Insulin	Anabolic to bone	Increased risk of falls due to hypoglycemia. Increased fracture risk could be a confounding effect of long disease duration, poor glycemic control and chronic complications
(2) Insulin secretagogues	Neutral	May increase risk of falls by causing hypoglycemia
(3) Metformin	Neutral or slightly positive	–
(4) Thiazolidinediones	Decrease BMD	Increase bone marrow adipogenesis and decrease osteoblastic differentiation
(5) GLP-1 agonists	Neutral or favourable	–
(6) Dipeptidyl peptidase 4 (DPP4) inhibitors	Neutral or favourable	–
(7) SGLT2 inhibitors	Increased fracture risk	Data are mainly with canagliflozin