In a real-world clinical setting of type 2 diabetes patients, sodium-glucose cotransporter-2 inhibitors (SGLT2i) use was not associated with an increase in fracture risk.

• The Korean National Health Insurance Service database was used to ascertain if SGLT2i were associated with elevated fracture risk in adults with type 2 diabetes than dipeptidyl peptidase-4 inhibitors (DPP-4i).

• Propensity score matching was done on 478,826 new users of an SGLT2 inhibitor or DPP-4 inhibitor, and post-propensity score matching on > 80 covariates, 84,460 persons were initiated on SGLT2i or DPP-4i, with 42,230 in each treatment group.

• In both as-treated (AT) and intention-to-treat (ITT) analyses, SGLT2i initiation was not associated with elevated fracture risk (AT: hazard ratio 0.98; ITT: hazard ratio 0.94).

• Subgroup analyses revealed absence of significant interaction between the individuals' age, gender, fracture history, or thiazolidinedione usage, suggesting that none of these variables seemed to be effect modifiers in the link between SGLT2i and fractures.