Jiao Zhao,1 Shan-shan Lv,2 Qi Lu,3 Xiao-xia Cong,4 Xian-feng Zhang1 

1Department of Endocrinology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People’s Republic of China; 3Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China; 4Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, Shandong, People’s Republic of China

Correspondence: Xian-feng Zhang, Department of Endocrinology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, No. 261, Huansha Road, Hangzhou, Zhejiang, 310000, People’s Republic of China, Email zhangxianfeng2018@qq.com

Abstract: Human life expectancy increases with social development, which poses problems related to rapid population ageing. As a common disease among the elderly, the prevention and control of diabetes is an ongoing challenge. Diabetes is associated with decreased bone mineral density, increased incidence of fractures, and decreased muscle strength. Meanwhile, the effects and mechanisms of different hypoglycemic drugs on musculoskeletal health vary. Currently, there are limited studies on the effects of anti-diabetic drugs on musculoskeletal health. However, it is necessary to take into account the effect of each hypoglycemic agent, alone or in combination, on musculoskeletal health when determining an individualized treatment approach. Medications that further negatively affect musculoskeletal health should be avoided in specific patients (eg thiazolidinediones and sodium-glucose cotransporter-2 inhibitors). At the same time, some hypoglycemic drugs can be used as potential targets for developing new therapies for osteoporosis/sarcopenia (eg metformin and glucagon-like peptide-1 receptor agonists). The aim of this review is to describe the effects and potential mechanisms of anti-diabetic drugs on musculoskeletal health, including metformin, insulin secretagogues, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter-2 inhibitors. This review will contribute to the choice of appropriate hypoglycemic drugs to maintain musculoskeletal health in patients.

Keywords: hypoglycemic agents, diabetes, osteoporosis, sarcopenia, fracture, molecular mechanism