Vitamin D supplements show promise in counteracting adverse effects of diabetes drugs on bone health

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Vitamin D supplementation may help offset the damaging bone loss that occurs in some people who take canagliflozin, a commonly prescribed diabetes medication. The researchers will present their work this week at the American Physiological Society (APS) and American Society for Nephrology Control of Renal Function in Health and Disease conference in Charlottesville, Virginia.

A class of diabetes drugs called SGLT2 inhibitors have been shown to slow the progression of diabetes-related kidney disease and are increasingly considered a first-line treatment option for people with diabetes who present with diabetes. a high risk of developing kidney and heart disease. However, some studies have shown that SGLT inhibitors negatively affect bone health by accelerating the loss of bone mineral density and impeding the body’s activation of vitamin D. The combination of these events can increase the risk of bone fracture. Researchers at the University of Maryland School of Medicine hypothesize that people who already have subnormal vitamin D levels have an even higher risk of bone loss and possible fracture when taking vitamin D supplements. SGLT2 inhibitors.

The research team studied adults from an Old Order Amish community in Lancaster, Pennsylvania. The researchers explained that they chose this population because of the availability of extensive genetic sequencing data, but also because, unlike commercially processed milk, the farm-fresh milk that many people in the Amish community drink n is not fortified with vitamin D. Therefore, the Amish are more likely to consume less vitamin D in their diets than the general population in the United States

The volunteers – some of whom had pre-existing low vitamin D levels – took the SGLT2 inhibitor canagliflozin for five days before and after receiving vitamin D supplements. The researchers found that in people with vitamin D deficiency D, canagliflozin caused a significant decrease (31%) in levels of a metabolite used to measure vitamin D levels, but a much smaller decrease (7%) in people with a normal vitamin. D status. The supplements then increased levels of parathyroid hormone, which regulates blood calcium levels and bone vitamin D levels.

The research team explained that the short-term study of vitamin D supplements to counter the adverse effects of SGLT2 inhibitors on bone health shows promising results, but more research is needed.

Longer term follow-up will be needed to determine if this accelerated loss of bone mineral density will eventually translate into an increased risk of bone fracture over the 10 to 20 years of chronic treatment. Accordingly, we recommend that patients and physicians consider taking vitamin D supplements to restore normal vitamin D status in vitamin D deficient patients receiving (or who will receive) SGLT2 inhibitors.”


Zhinous Yazdi, MD, first author of the study

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