Diabetes drugs tied to falls? Large geriatric study finds no link

Sodium–glucose cotransporter 2 (SGLT2) inhibitors, a widely prescribed class of diabetes drugs celebrated for protecting the heart and kidneys, do not appear to raise the risk of repeated falls in older adults, according to a retrospective cross-sectional study of 1,069 Turkish patients aged 65 and over who underwent comprehensive geriatric assessment. The findings, published in BMC Pharmacology and Toxicology, instead point the finger at two established culprits: antidepressants and antimuscarinic drugs.

Falls are one of the most consequential geriatric syndromes, driving morbidity, functional decline and loss of independence in later life. Because SGLT2 inhibitors have transformed cardiometabolic care, clinicians have wondered whether the drugs might contribute to falls, perhaps through dehydration, dizziness or urinary urgency. Evidence to date has been limited and inconsistent, prompting the research team to investigate the association directly and to benchmark it against medication classes already recognised as fall-risk-increasing drugs.

The study drew on adults aged 65 or older who had completed comprehensive geriatric assessment, a structured evaluation covering nutrition, function, frailty, comorbidities and medication use. Recurrent falls were defined as two or more falls during the previous year. Of the 1,069 participants, 298, or 27.9 percent, had such a history. The researchers recorded demographic characteristics, comorbidities, laboratory findings, use of SGLT2 inhibitors and other medications, and geriatric assessment parameters, then used logistic regression with sequential adjustment for confounding factors to identify medication groups associated with recurrent falls.

Fallers differed from non-fallers in ways consistent with geriatric medicine’s broader picture: they were older, carried a higher comorbidity burden, showed poorer nutritional and functional status, had greater frailty and used more medications concurrently, a pattern known as polypharmacy. These differences reached statistical significance and underscored why the investigators adjusted for confounders before judging any single drug class.

Against that backdrop, SGLT2 inhibitor use showed no association with recurrent falls. The drugs were used by 12.4 percent of recurrent fallers compared with 9.5 percent of non-fallers, a difference that did not reach statistical significance (p = 0.157). SGLT2 inhibitor use was likewise unrelated to Timed Up and Go test duration, a standard measure of mobility and fall risk (p = 0.975). In multivariable logistic regression, after full adjustment for confounders, SGLT2 inhibitor use carried an odds ratio of 1.30 with a 95 percent confidence interval of 0.79 to 2.13 (p = 0.299), a range that includes no association.

The contrast with established fall-risk-increasing drugs was striking. Antidepressant use remained independently associated with recurrent falls after full adjustment, with an odds ratio of 1.61 (95 percent CI 1.18 to 2.20; p = 0.002). Antimuscarinic drugs, which block receptors involved in bladder control and are commonly prescribed for overactive bladder, showed an even stronger signal, with an odds ratio of 2.28 (95 percent CI 1.44 to 3.62; p < 0.001). Both classes have long featured on lists of medications that warrant scrutiny in older patients.

As a retrospective cross-sectional analysis, the study captures associations at a single point in time rather than tracking participants forward, so it cannot establish that any drug causes falls. The authors’ conclusions are framed accordingly: SGLT2 inhibitor use was not independently associated with recurrent falls in this population, and the findings suggest that when clinicians evaluate potentially inappropriate medications for fall risk or consider deprescribing, established fall-risk-increasing drugs, particularly antidepressants and antimuscarinic agents, may deserve greater attention during medication review than SGLT2 inhibitors.

For a rapidly ageing global population, the practical implications are considerable. Medication review is a cornerstone of falls prevention, and deprescribing decisions must balance each drug’s benefits against its risks. The study’s results suggest that the diabetes drugs at the centre of contemporary cardiometabolic practice need not be a primary target in that balancing act, while the sedation, anticholinergic and other effects associated with antidepressants and antimuscarinics remain firmly on the watch list. With 27.9 percent of this geriatric cohort reporting recurrent falls, the burden at stake is far from trivial.

The work also illustrates the value of comprehensive geriatric assessment as a research platform: by capturing nutrition, function, frailty, comorbidity and medication data in one framework, it allowed the investigators to separate drug-specific signals from the general frailty that accompanies ageing. Larger prospective studies in other populations would help confirm the pattern, but for now the message for prescribers is measured: in this Turkish geriatric cohort, SGLT2 inhibitors were not linked to recurrent falls, whereas antidepressants and antimuscarinic drugs were independently associated with them.

Subject of Research: Association between SGLT2 inhibitor use and recurrent falls in older adults undergoing comprehensive geriatric assessment

Article Title: Sodium–glucose cotransporter 2 inhibitor use and recurrent falls in Turkish older adults: a cross-sectional comparison with established fall-risk-increasing drugs

Article References: Kaya, B. U., Baykan, K. B., Kaya, I. S., Onal, Y., Katipoglu, B., & Kocyigit, S. E. (2026). Sodium–glucose cotransporter 2 inhibitor use and recurrent falls in Turkish older adults: a cross-sectional comparison with established fall-risk-increasing drugs. BMC Pharmacology and Toxicology. https://doi.org/10.1186/s40360-026-01277-y

Image Credits: AI Generated

DOI: 10.1186/s40360-026-01277-y

Keywords: SGLT2 inhibitors, recurrent falls, older adults, comprehensive geriatric assessment, antidepressants, antimuscarinic drugs, polypharmacy, frailty, deprescribing, medication review, geriatric syndromes, cross-sectional study